Failure of third ventriculostomy in the treatment of aqueductal stenosis in children

Cinalli, Giuseppe; Sainte‐Rose, Christian; Chumas, Paul; Zérah, Michel; Brunelle, Françis; Lot, Guillaume; Pierre-Kahn, Alain; Rénier, Dominique

doi:10.3171/jns.1999.90.3.0448

Cited by 292 publications

(182 citation statements)

References 15 publications

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“…However, a longer follow-up period is undoubtedly required, since delayed failure following ETV has been reported even 5.9 years following the procedure [20]. In our series ETV failed after 2 years in a patient with postmeningitic hydrocephalus despite an excellent initial result.…”

Section: Discussionmentioning

confidence: 75%

“…However, Grant and McLone [1]and Buxton et al [5]reported success rates as high as 23% in an unselected group of children less than 1 year old and recommended that ETV should be used as first-line treatment for hydrocephalus in this age group to avoid shunt-related morbidity, mortality, and economic implications. In a retrospective study of 213 children with obstructive hydrocephalus, Cinalli et al [20]reported that when third ventriculostomy was performed with endoscopic guidance, no difference was found in the long-term outcome between children younger than 6 months and older ones. The authors suggested that this improved long-term outcome could be due to more accurate patient selection and/or the technical advantages of endoscopy as compared with ventriculographic guidance, allowing direct visualization of the third ventricular floor and the anatomical landmarks of the interpeduncular cistern.…”

Section: Discussionmentioning

confidence: 99%

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The Impact of Endoscopic Third Ventriculostomy on the Management of Newly Diagnosed Hydrocephalus in Infants

et al. 2001

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Objectives: To evaluate the role of endoscopic third ventriculostomy (ETV) as a primary treatment for hydrocephalus in children less than 1 year old and to determine its impact as a whole on the reduction of shunts necessary in a new population of hydrocephalic infants. Methods: Data were collected prospectively on 47 infants with newly diagnosed hydrocephalus of all aetiologies who were referred between 1st April 1998 and 30th September 2000. Twenty-one patients (median age 6 weeks, range 34 weeks of gestation to 10 months) underwent ETV, while the remaining 26 patients had insertion of a ventriculoperitoneal shunt. Anatomical criteria and demonstration of third ventricle outflow obstruction on preoperative magnetic resonance imaging were used to select patients for ETV. Results: There was no mortality or major morbidity following ETV. The median follow-up period was 18 (range 8–36) months. During the follow-up period, the ETV remained patent in 7 (33%) of the 21 patients. Of the 14 patients with failed ETV, 11 had insertion of a ventriculoperitoneal shunt, while 3 have undergone successful redo ETV. Therefore, in total 10 patients (48%) of the ETV group remain shunt independent. The best results were obtained in patients with congenital aqueduct stenosis with 71% (5 of 7 patients) success rate, while patients with posthaemorrhagic hydrocephalus did particularly badly with only 1 of 10 patients having a successful ETV. Overall, 10 of 47 (21%) infants with newly diagnosed hydrocephalus have avoided a shunt. Conclusions: Our results suggest that the selective use of ETV as the primary treatment in infants with hydrocephalus is safe and can lead to a reduction in the shunted population of all newly diagnosed hydrocephalic infants by up to 21%. Success of ETV is aetiology, not age dependent.

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Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

The Impact of Endoscopic Third Ventriculostomy on the Management of Newly Diagnosed Hydrocephalus in Infants

et al. 2001

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“…Possibly, young children with open sutures are not able to generate a sufficient pressure gradient across the arachnoid granulations for reabsorption [25]. Some authors report substantially better results with success rates between 57 and 87% [26, 27]. For these authors, the reported poor results are not related to the immaturity of the CSF pathways but to poor selection criteria for ETV.…”

Section: Discussionmentioning

confidence: 81%

Endoscopic Transtentorial Ventriculocystostomy and Cystoventriculoperitoneal Shunt in a Neonate with Dandy-Walker Malformation and Associated Aqueductal Obstruction

et al. 2005

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Objective: Shunting of the lateral ventricle and the posterior fossa cyst is the advocated surgical therapy for children with Dandy-Walker malformation (DWM) and associated aqueductal obstruction. The high rate of complications of combined shunting stimulated the authors to search for an alternative surgical solution. Clinical Presentation/Intervention: After transtentorial endoscopic ventriculocystostomy, a cystoventricular catheter, connected to a peritoneal shunt, was placed in a neonate with DWM and associated aqueductal obstruction. Immediately prior to ventriculocystostomy, the presence of a blocked third ventricular outflow was reconfirmed by contrast medium injection. Neuronavigation was required to define the surgical path from the lateral ventricle through the tentorium and the overlying small rim of brain parenchyma into the posterior fossa cyst. The postoperative clinical course was uneventful with radiologically proven reduction of the size of the ventricular system and the cyst. Conclusion: Cystoventriculoperitoneal shunt placement after transtentorial endoscopic ventriculostomy is a surgical alternative in very young children with DWM and associated aqueductal obstruction.

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“…In addition, if TV fails in the future, the shunt can be unligated if we leave the shunt system in place. In order to justify VP shunt removal, we also have to consider the long-term outcome of TV [15, 20]compared with VP shunt. At the time of writing, such reports are still few in number.…”

Section: Discussionmentioning

confidence: 99%

Critical Shunt-Induced Subdural Hematoma Treated with Combined Pressure-Programmable Valve Implantation and Endoscopic Third Ventriculostomy

Fukuhara

Vorster

Luciano³

2000

Pediatr Neurosurg

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The authors present 2 patients with VP shunt-induced subdural hematomas (SDH) treated with pressure-programmable valve implantation and endoscopic third ventriculostomies (TV). The first patient is an 11-year-old girl who developed a shunt-induced SDH. Revision of the shunt valve with a higher-pressure valve resulted in a prolonged deterioration of her consciousness. External ventricular drainage at low pressure led to clinical improvement. A pressure-programmable valve set at 50 mm H₂O was implanted, and the pressure gradually increased. At a pressure of 120 mm H₂O symptoms recurred, even though the subdural collection was beginning to decrease in size. An endoscopic TV was performed, and the valve pressure was then increased to 200 mm H₂O without any neurological symptoms. The second patient, a 7-year-old boy with shunt-induced SDH, had recurrent SDH, even after shunt revision with placement of a higher-pressure valve, which resulted in prolonged lethargy. A pressure-programmable valve was implanted with concurrent endoscopic TV. Gradual valve pressure increases up to 200 mm H₂O could be performed without recurrent symptoms. Eventually, the shunt system was ligated to resolve residual positional headache, and the TV has been patent for more than 3 years. In both patients, the pressure-programmable valve was useful, since the optimal CSF drainage pressure changed during the period of recovery from symptomatic subdural collections. Concurrent TV appeared to enable increasing the valve pressure gradually without any neurological symptoms. The advantages of this combined approach are discussed.

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Failure of third ventriculostomy in the treatment of aqueductal stenosis in children

Cited by 292 publications

References 15 publications

The Impact of Endoscopic Third Ventriculostomy on the Management of Newly Diagnosed Hydrocephalus in Infants

The Impact of Endoscopic Third Ventriculostomy on the Management of Newly Diagnosed Hydrocephalus in Infants

Endoscopic Transtentorial Ventriculocystostomy and Cystoventriculoperitoneal Shunt in a Neonate with Dandy-Walker Malformation and Associated Aqueductal Obstruction

Critical Shunt-Induced Subdural Hematoma Treated with Combined Pressure-Programmable Valve Implantation and Endoscopic Third Ventriculostomy

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