Endoscopic third ventriculostomy in patients with myelomeningocele after shunt failure

Furtado, Leopoldo Mandic Ferreira; Filho, José Aloysio da Costa Val; Holliday, Julia Braga; Costa, Júlia da Silva; Matos, Marcelle Amaral de; Nascimento, Victor Adalberto Machado; Cavalcanti, Túlio Ramos

doi:10.1007/s00381-020-04596-5

Cited by 16 publications

(17 citation statements)

References 23 publications

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“…Furthermore, an anomalous IIIVT oor is correlated with a higher rate of ETV failure in the rst six months after the procedure and was a valid intraoperative parameter impacting the ETV success rate. This impression aligns with several reports that have considered the anatomic aspects of TC and LM and could assist surgeons in identifying procedures that may be di cult or require extra care [3,9,10,20,21,23,24,28,35,39,43,47,46,51].…”

Section: Impact Of Tc/lm Anatomy On Etvsupporting

confidence: 86%

“…A high failure rate of ETV was observed in myelomeningocele patients (60%) and in patients younger than one month of life (75%). This also represents the more di cult level at which ETV must be performed in both situations, as well as the lower probability for success based on the ETVSS [20,35]. This fact could explain the variations in =predictability of ETVSS at di cult levels in our sample.…”

Section: Impact Of Tc/lm Anatomy On Etvmentioning

confidence: 83%

“…ETV success and technical aspects of the TC/LM overture Currently, ETV is widely performed [49,42,41,27,25,20,40,26,7,39]. However, discrepancies in its e cacy can be found throughout the literature [3,7,4,13,25,26,40,42,46].…”

Section: Impact Of Tc/lm Anatomy On Etvmentioning

confidence: 99%

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The Role of the Liliequist Membrane in the Third Ventriculostomy

Jacv¹,

SNdS

Lmf

et al. 2021

Preprint

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Endoscopic third ventriculostomy (ETV) is a hydrocephalus treatment procedure that involves opening the Liliequist membrane (LM). However, LM anatomy has not been well-studied neuroendoscopically, because approach angles differ between descriptive and microsurgical anatomical explorations. Discrepancies in ETV efficacy, especially among children age 2 and younger, may be due to incomplete LM opening. The objective of this study was to characterize the LM anatomically from a neuroendoscopic perspective to better understand the impact of anatomical features during LM ostomy and the ETV success rate. Additionally, the ETV success score was tested to predict patient outcome after the intraoperatively difficult opening of LM. Fifty-four patients who underwent ETV were prospectively analyzed with a mean follow-up of 53.1 months (1–90 months). The ETV technical parameters of difficulty were validated by seven expert neurosurgeons. The pediatric population (44) of this study represents the majority of patients (81.4%). The overall ETV success rate was 68.5%. Anomalies on the IIIVT floor resulted in an increased rate of ETV failure. The IIIVT was anomalous, and LM was thick in 33.3% of cases. Fenestration of LM was difficult in 39% of cases, and the LM and TC were opened separately in 55.6% of cases. The endoscopic third ventriculostomy success score (ETVSS) accurately predicted the level of difficulty opening the LM (p = 0.012), and the group with easy opening presented greater durability in ETV success. Neurosurgeons should be aware of the difficulty level of the overture of LM during ETV and its impact on long-term ETV effectiveness.

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Section: Impact Of Tc/lm Anatomy On Etvsupporting

confidence: 86%

Section: Impact Of Tc/lm Anatomy On Etvmentioning

confidence: 83%

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The Role of the Liliequist Membrane in the Third Ventriculostomy

Jacv¹,

SNdS

Lmf

et al. 2021

Preprint

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“…Magnetic resonance imaging is effective in assessing ventricle dilation and anatomy of the third ventricle. If we can predict at least 50% chance of success, we perform ETV [48].…”

Section: Abdominal Pseudocystmentioning

confidence: 99%

Abdominal Complications Related to Ventriculoperitoneal Shunt Placement: A Comprehensive Review of Literature

Furtado¹,

Filho²,

Faleiro³

et al. 2021

Cureus

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Ever since the shunt device became the gold standard treatment for hydrocephalus, complications due to infections and mechanical problems have increased while lives have been saved. In addition, abdominal complications have become an important issue as the peritoneum is now the main place to insert the distal catheter. The most common complications were abdominal pseudocyst, distal catheter migration, inguinal hernia, catheter disconnection, and intestinal obstruction. The pediatric population is more prone to develop most of these complications due to their rapidly growing body, weaker abdominal musculature, and increased intraabdominal pressure. The goal of this review was to study the main aspects associated with abdominal complications after ventriculoperitoneal shunt (VPS) insertion, including the pathophysiology, epidemiological aspects, as well as the rationale for management and prevention according to the current "state-of-the-art." It is paramount to recognize the risk factors associated with various types of complications to manage them properly.

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“…The main advantage of extirpation of the GCP in addition to CPC is the improvement in surgical efficiency because this portion of the choroid plexus is more mobile than other segments, especially in patients with myelomeningocele and colpocephaly [15]. Neuroendoscopic procedures involve only one portal, and the tip of a monopolar or bipolar diathermy device frequently adheres to the glomus, thereby increasing the risk of bleeding and lengthening the procedure.…”

Section: Figure 10: the Choroid Plexus Fixation On The Lateral Ventrimentioning

confidence: 99%

Selective Neuroendoscopic Resection of the Choroid Plexus as an Alternative Technique for Optimizing the Standard Endoscopic Approach to Hydrocephalus

Furtado¹,

Filho²,

Sousa³

et al. 2020

Cureus

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In the past four decades, enormous advances have been made in the neuroendoscopic techniques, along with improvement of illumination, and the development of effective instruments. As a result, endoscopic third ventriculostomy (ETV) and choroid plexus cauterization (CPC) have become consolidated techniques for the treatment of hydrocephalus. In particular, endoscopic cauterization of the choroid plexus has increased the effectiveness of hydrocephalus treatment in combination with ETV. In the past decade, the use of flexible endoscopes has enabled surgeons to resect even the temporal segment of the choroid plexus at the lateral ventricles, which has increased the success of treatment. In this technical note, we describe CPC with the use of a rigid endoscope, which we used to selectively disconnect the glomus of the choroid plexus, in addition to choroid plexus coagulation, as an alternative way to facilitate ETV. This new procedure optimized the visualization of the choroid plexus and the temporal horn and prevented additional difficulties in coagulation of this mobile region of the choroid plexus in selected patients. To achieve the best outcome, avoid bleeding, and optimize the standard technique, it was important to recognize both the classical anatomic structure of the choroid plexus and some variations, and previous expertise in ETV and CPC were necessary. We demonstrate that resection of the glomus of the choroid plexus in selected patients is safe and feasible.

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Endoscopic third ventriculostomy in patients with myelomeningocele after shunt failure

Cited by 16 publications

References 23 publications

The Role of the Liliequist Membrane in the Third Ventriculostomy

The Role of the Liliequist Membrane in the Third Ventriculostomy

Abdominal Complications Related to Ventriculoperitoneal Shunt Placement: A Comprehensive Review of Literature

Selective Neuroendoscopic Resection of the Choroid Plexus as an Alternative Technique for Optimizing the Standard Endoscopic Approach to Hydrocephalus

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