Endoscopic third ventriculostomy for hydrocephalus: early and late efficacy in relation to aetiology

Kwiek, S; Mandera, Marek; Bazowski, P; Luszawski, Jerzy; Duda, Izabela; Wolwender, Adam; Zymon-Zagórska, Anna; Grzybowska, Konstancja

doi:10.1007/s00701-002-1063-x

Cited by 31 publications

(10 citation statements)

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“…Incidences of CSF leak after ETV have varied between 2% and 7%. [616] The cause of persistent leak following ETV was probably nonpatent subarachnoid space in the face of a demonstrated open stoma on repeat ETV. After routinely closing the dura during ETV, the rate of CSF has been nil.…”

Section: Discussionmentioning

confidence: 99%

Outcome of endoscopic third ventriculostomy and Chhabra shunt system in noncommunicating non-tumor childhood hydrocephalus

2009

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Background:Endoscopic third ventriculostomy (ETV) the main alternative to ventriculoperitoneal shunt (VPS) is just beginning to have a foothold in West Africa. It provides a great opportunity for a hydrocephalic child to be shunt free. The purpose of this paper is to compare outcome following ETV and VPS (using the cheap Chhabra shunt) in children with noncommunicating non-tumoral hydrocephalus in an environment where late presentation is the norm.Materials and Methods:Sixty-three pediatric patients (< 6 years) with hydrocephalus who underwent a VPS or ETV at our hospital were included in this study. The study period was of 30 months (January 2006 till June 2008). Clinically successful outcome was defined as no event occurring during or after surgery that resulted in an alternate surgical procedure, or significant post-operative complication that includes death. All complications related to the procedures were also analyzed.Results:The outcome of surgical intervention was not significantly related to the gender, age of the patient at surgery, or type of surgery. The post-operative complication rate was similar in both groups.Conclusions:The clinical outcome of ETV is comparable to that of VPS, with the added benefit of no shunt-related problems; and being a short procedure, patient anesthesia and operation time, hospital stay, and cost are significantly reduced. We consider ETV to be the procedure of choice for the treatment of noncommunicating nontumoral hydrocephalus in the pediatric population.

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Section: Discussionmentioning

confidence: 99%

Outcome of endoscopic third ventriculostomy and Chhabra shunt system in noncommunicating non-tumor childhood hydrocephalus

2009

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“…Many different neuroendoscopic indications have since been described, and reports on successful endoscopic treatments for various pathological entities such as obstructive hydrocephalus of any origin, 1,[4][5][6]8,10,13,17,[21][22][23]25,[29][30][31][32]38,40,42,48,51 arachnoid cysts, 2,7,9,12,20,24,26,28,35,39,46,47,50 septum pellucidum cysts, 14,19,34 and intra-and paraventricular tumors 16,33 have been frequent. Even in rare cystic lesions 18 or idiopathic normal pressure hydrocephalus, 18 successful CSF circulation restoration has been described with endoscopy.…”

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confidence: 99%

Endoscopic options in children: experience with 134 procedures

Oertel

Baldauf

Schroeder

et al. 2009

PED

106

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Object There are frequent applications for endoscopy in neurosurgery. However, endoscopic surgery in children has peculiar characteristics and is associated with different rates of success. In this study, the authors report on their experience with 134 consecutive endoscopy procedures performed in 126 patients < 18 years of age. Methods Between April 1993 and October 2007, 134 endoscopic procedures were performed in 126 children. Indications for surgery included brain tumors in 48 children, cystic lesions in 24, aqueductal stenosis in 23, various malformations in 20, hemorrhage and infarction in 6, and isolated ventricles in 5 children. In this long-term followup study, data were analyzed with respect to clinical and radiological success rates, as well as shunt dependence both in relation to lesion origin, and to the type of endoscopic procedure performed (endoscopic third ventriculostomy [ETV], septostomy, aqueductoplasty, or cystocisternostomy). Finally, the influence of patient age on the success rate was evaluated. Results In 114 patients, restoration of CSF circulation was the goal of endoscopy, but in 2 patients only ventriculoscopy was performed followed by ventriculoperitoneal shunt placement. In 12 of 114 patients, tumor biopsy sampling or resection was performed simultaneously with shunt placement. In another 12 patients, only endoscopic tumor resection without CSF circulation restoration was done. The follow-up period ranged from 1 to 6 years. Thirteen tumor biopsies, 7 partial tumor resections, and 4 endoscopically complete tumor resections were performed. An intraoperative switch to microsurgery was made in 2 patients because of recurrent hemorrhage and an overly time-consuming endoscopic surgery. Cerebrospinal fluid circulation was successfully restored in 81 (72%) of 112 patients, with the use of endoscopy in the setting of tumor-related hydrocephalus providing the best results (86% success rate). However, of the various endoscopic procedures, cyst openings (cystocisternostomy, cystoventriculostomy, and ventriculocystocisternostomy) provided the best results—superior even to ETV—with a success rate of 77% and no complications. In contrast, endoscopic aqueductoplasty had a high failure and complication rate. Patients < 6 months old who underwent ETV, septostomy, or aqueductoplasty had poor results and became more frequently shunt dependent than older children. Conclusions Overall, endoscopy can be considered safe and effective in children. Based on the authors' data, acute hydrocephalus cases such as those caused by tumors are the best candidates for endoscopic CSF flow restoration. Interestingly, cyst openings to the ventricles or cisterns were the most successful endoscopic techniques with the lowest complication rate. Aqueductoplasty should be reserved for selected cases. Finally, the success rate of endoscopic techniques remains poor in infants < 6 months of age; this was not only true of ETV, but also other techniques such as septostomy and aqueductoplasty.

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“…All patients with triventricular hydrocephalus with sufficient dilatation of the third ventricle are amenable to ETV. The ETV is a minimally invasive procedure, is safe and is especially effective and useful in non-communicating HCP [1–4, 6, 7, 10, 11]. Alleviation or diminishment of symptoms associated with increased ICP occurred in patients with idiopathic stenosis of the aqueduct in 6 cases in our group, and obstructive HCP caused by tumor in 32 cases.…”

Section: Discussionmentioning

confidence: 90%

Endoscopic third ventriculostomy in treatment of hydrocephalus.

Sokal¹,

Birski²,

Rusinek³

et al. 2012

Videosurgery and Other Miniinvasive Techniques

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IntroductionEndoscopic third ventriculostomy (ETV) is a minimally invasive method of treatment of obstructive hydrocephalus (HCP).AimTo investigate perioperative and intraoperative difficulties, failures and complications of ETV.Material and methodsSeventy-three procedures of ETV were conducted in our department in the last 5 years on 69 patients with HCP of different etiology. In 4 patients we performed ETV twice. In 4 cases we used neuronavigation. In 6 cases ETV was performed in conjunction with endoscopic biopsy of the tumor. In 6 cases we had to repeat the procedure (4) or implant a ventriculo-peritoneal shunt (2) due to recurrence of symptoms.ResultsIn our series we had 3 important complications: one thalamic injury and 2 intraventricular hemorrhages. In 4 cases we observed postoperative hyperthermia with the presence of meningeal symptoms. Two cerebrospinal fluid (CSF) leaks were secured with additional stitches and 2 CSF infections were treated with antibiotics. In 1 patient epileptic seizers were observed. Three others complained of nausea and vomiting. The initial success rate of ETV is 70%.ConclusionsBased on our material we conclude that ETV is a useful and helpful procedure in non-communicating HCP. It carries 4% perioperative risk of serious complications which can be reduced by proper selection of patients, detailed plan and skilful performance of surgery in experienced hands and meticulous postoperative care.

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Endoscopic third ventriculostomy for hydrocephalus: early and late efficacy in relation to aetiology

Abstract: ETV is effective in well chosen patients in relieving symptoms of hydrocephalus. It is valuable before a definitive major operation to remove the cause of hydrocephalus, as a palliative treatment, and in itself as a method of definitive management when indications are correct.

Cited by 31 publications

References 0 publications

Outcome of endoscopic third ventriculostomy and Chhabra shunt system in noncommunicating non-tumor childhood hydrocephalus

Outcome of endoscopic third ventriculostomy and Chhabra shunt system in noncommunicating non-tumor childhood hydrocephalus

Endoscopic options in children: experience with 134 procedures

Endoscopic third ventriculostomy in treatment of hydrocephalus.

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