Early Third Ventriculostomy in Meningomyelocele Infants – Shunt Independence?

Natelson, Stephen E.

doi:10.1159/000119997

Cited by 11 publications

(11 citation statements)

References 8 publications

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“…Possible contraindications have ineluded congenital aqueductal stenosis (6), age < 2 years (5,27), age < 1 year (9), age < 2 months (17), intraventricular hemorrhage (6,27), meningitis (5-7,27), congenital toxoplasmosis (6,13,27), myolomeningocele (3,12,16), prior radiation therapy (3,14), Dandy-Walker (13,24), prior VP shunt (7,13), subdural hematomas (14) and tumors or vascular malformations of the floor of the third ventriele (3). Nevertheless, reasonable success rates have been reported in patients with myelomeningocele (3,8,14,22,31), Chiari malformation (14,31), congenital aqueductal stenosis (7,8,14), previous infection (14,39) and age < 2 years (6)(7)(8)14).…”

Section: Discussionmentioning

confidence: 99%

Third Ventriculostomy: Post-operative Ventricular Size and Outcome

Th¹,

Yoon²,

Fw³

et al. 1996

Minim Invasive Neurosurg

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Reduction in ventricular size after third ventriculostomy often appears minimal. In order to determine if changes in ventricular size are a reliable measure of a functioning ventriculostomy, and which ventricle is more sensitive to this change, we compared pre-operative lateral and third ventricular diameter with serial post-operative axial CT and/or MRI scans in a series of 27 consecutive third ventriculostomies. Of eleven patients with aqueductal stenosis, fifteen with mass lesions and one with a Chiari I, six patients were shunted before 1 month and two refused radiographic follow-up. In the remaining nineteen patients, with an average follow-up of 20 months, the average (s.d.) third ventricular change was -30 (11)% for twelve improved patients, and +13 (18)% for the seven patients without improvement (p < 0.00001). The average (s.d.) lateral ventricular change was -23 (15)% for improved patients, and +5 (21)% for those without improvement (p < 0.005). A decrease in third ventricular size by a least 15% was seen in all significantly improved patients. Similar results were found in 9 patients with scans performed exactly one month post-operatively. Among the aqueductal stenosis patients, factors associated with failure were age > 70 years associated with symptoms of NPH, symptomatic, shunted hydrocephalus since before age 1 year and a history of meningitis. In the remaining patients, failures occurred with a history of meningitis, subdural hematoma, Chiari I malformation or following open tumor surgery or intraventricular AVM rupture. Although both the lateral and third ventricles change in diameter after third ventriculostomy, the third ventricular diameter is more reliable. As early as one month post-operatively, ventricular diameter reflects the clinical outcome of the operation. A decrease in third ventricular diameter by at least 15% was seen in all successful cases and in none of the failures.

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Section: Discussionmentioning

confidence: 99%

Third Ventriculostomy: Post-operative Ventricular Size and Outcome

Th¹,

Yoon²,

Fw³

et al. 1996

Minim Invasive Neurosurg

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“…Among the most common causes of congenital hydrocephalus has been that associated with myelomeningocele and Chiari malformation type II (45). Until recently, hydrocephalus was reported to require treatment in 80% to 90% of these children (63,68).…”

Section: Etv In Congenital Abnormalitiesmentioning

confidence: 99%

Indication for Endoscopic Third Ventriculostomy

Mugamba¹,

Stagno²

2013

World Neurosurgery

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“…The exact etiology of hy drocephalus in this population varies [1,2], The lowgrade ventriculitis and meningitis present with an open lesion has been implicated, but so too have the Chiari malformation, the hypoplastic arachnoid villi and con comitant aqueduct stenosis. All these findings play roles in the pathogenesis of hydrocephalus, but whether it is communicating or not depends on the predominance of one factor over another.…”

Section: Introductionmentioning

confidence: 99%

“…However, its use in the management of a child with spina bifida remains controversial [2,12] and in some opinions is con traindicated. Ideally, a preoperative study that could de termine whether the cerebrospinal fluid (CSF) pathways would become functional might offer a means of predict ing the success of ETV, but as yet such a study is unavail able.…”

Section: Introductionmentioning

confidence: 99%

Management of Hydrocephalus by Endoscopic Third Ventriculostomy in Patients with Myelomeningocele

1996

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Endoscopic third ventriculostomy (ETV) was performed between July 1978 and July 1995 on 69 patients with hydrocephalus and myelomeningocele. Most of the patients had been previously shunted, although in 14 patients ETV was the initial treatment. Patient selection was based on preoperative imaging studies suggesting noncommunicating hydrocephalus. Only 2 patients exhibited transient hypothalamic dysfunction with complete resolution. Patients were assessed by their clinical status, imaging characteristics, and, in some cases, formal psychometric studies. The overall success rate was 72%, although selecting only patients who have been previously shunted or who were over 6 months of age at the time of endoscopy increases this to 80%. Our results indicate that ETV is a safe and effective means of treating hydrocephalus in the older spina bifida population and offers the hope of long-term, shunt-independent life for selected patients.

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Early Third Ventriculostomy in Meningomyelocele Infants – Shunt Independence?

Cited by 11 publications

References 8 publications

Third Ventriculostomy: Post-operative Ventricular Size and Outcome

Third Ventriculostomy: Post-operative Ventricular Size and Outcome

Indication for Endoscopic Third Ventriculostomy

Management of Hydrocephalus by Endoscopic Third Ventriculostomy in Patients with Myelomeningocele

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