Long-term change in ventricular size following endoscopic third ventriculostomy for hydrocephalus due to tectal plate gliomas

Romeo, Andrew; Naftel, Robert P.; Griessenauer, Christoph J.; Reed, Gavin T.; Martin, Richard; Shannon, Chevis N.; Grabb, Paul A.; Tubbs, R. Shane

doi:10.3171/2012.9.peds12243

Cited by 22 publications

(21 citation statements)

References 29 publications

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“…The failure of ETV is often hard to define since ventricle size is known to remain large even in seemingly successful cases. 12,21,22 Although the impact of persistently enlarged ventricles on long-term outcome is still a point of debate, 11,19,25 the tolerance for larger ventricles does result in different standards for declaring treatment failure compared with shunt failure. Treating surgeons may also have a natural tendency to under-report complications.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic third ventriculostomy in children: prospective, multicenter results from the Hydrocephalus Clinical Research Network

Kulkarni

Riva-Cambrin

Holubkov

et al. 2016

PED

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119

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OBJECTIVE Endoscopic third ventriculostomy (ETV) is now established as a viable treatment option for a subgroup of children with hydrocephalus. Here, the authors report prospective, multicenter results from the Hydrocephalus Clinical Research Network (HCRN) to provide the most accurate determination of morbidity, complication incidence, and efficacy of ETV in children and to determine if intraoperative predictors of ETV success add substantially to preoperative predictors. METHODS All children undergoing a first ETV (without choroid plexus cauterization) at 1 of 7 HCRN centers up to June 2013 were included in the study and followed up for a minimum of 18 months. Data, including detailed intraoperative data, were prospectively collected as part of the HCRN's Core Data Project and included details of patient characteristics, ETV failure (need for repeat hydrocephalus surgery), and, in a subset of patients, postoperative complications up to the time of discharge. RESULTS Three hundred thirty-six eligible children underwent initial ETV, 18.8% of whom had undergone shunt placement prior to the ETV. The median age at ETV was 6.9 years (IQR 1.7–12.6), with 15.2% of the study cohort younger than 12 months of age. The most common etiologies were aqueductal stenosis (24.8%) and midbrain or tectal lesions (21.2%). Visible forniceal injury (16.6%) was more common than previously reported, whereas severe bleeding (1.8%), thalamic contusion (1.8%), venous injury (1.5%), hypothalamic contusion (1.5%), and major arterial injury (0.3%) were rare. The most common postoperative complications were CSF leak (4.4%), hyponatremia (3.9%), and pseudomeningocele (3.9%). New neurological deficit occurred in 1.5% cases, with 0.5% being permanent. One hundred forty-one patients had documented failure of their ETV requiring repeat hydrocephalus surgery during follow-up, 117 of them during the first 6 months postprocedure. Kaplan-Meier rates of 30-day, 90-day, 6-month, 1-year, and 2-year failure-free survival were 73.7%, 66.7%, 64.8%, 61.7%, and 57.8%, respectively. According to multivariate modeling, the preoperative ETV Success Score (ETVSS) was associated with ETV success (p < 0.001), as was the intraoperative ability to visualize a “naked” basilar artery (p = 0.023). CONCLUSIONS The authors' documented experience represents the most detailed account of ETV results in North America and provides the most accurate picture to date of ETV success and complications, based on contemporaneously collected prospective data. Serious complications with ETV are low. In addition to the ETVSS, visualization of a naked basilar artery is predictive of ETV success.

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Section: Discussionmentioning

confidence: 99%

Endoscopic third ventriculostomy in children: prospective, multicenter results from the Hydrocephalus Clinical Research Network

Kulkarni

Riva-Cambrin

Holubkov

et al. 2016

PED

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119

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“…Endoscopic third ventriculostomy has proven to be an effective method of CSF diversion 17,23 and allows for biopsy of the tumor or even partial resection in selected cases. 4 Long-term ETV success rates for this entity of greater than 70% up to around 90% have been reported.…”

Section: Discussionmentioning

confidence: 99%

Pediatric tectal plate gliomas: clinical and radiological progression, MR imaging characteristics, and management of hydrocephalus

Griessenauer

Rizk

Miller

et al. 2014

PED

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Object Tectal plate gliomas are generally low-grade astrocytomas with favorable prognosis, and observation of the lesion and management of hydrocephalus remain the mainstay of treatment. Methods A cohort of patients with tectal plate gliomas at 2 academic institutions was retrospectively reviewed. Results Forty-four patients with a mean age of 10.2 years who harbored tectal plate gliomas were included in the study. The mean clinical and radiological follow-up was 7.6 ± 3.3 years (median 7.9 years, range 1.5–14.7 years) and 6.5 ± 3.1 years (median 6.5 years, range 1.1–14.7 years), respectively. The most frequent intervention was CSF diversion (81.8% of patients) followed by biopsy (11.4%), radiotherapy (4.5%), chemotherapy (4.5%), and resection (2.3%). On MR imaging tectal plate gliomas most commonly showed T1-weighted isointensity (71.4%), T2-weighted hyperintensity (88.1%), and rarely enhanced (19%). The initial mean volume was 1.6 ± 2.2 cm3 and it increased to 2.0 ± 4.4 cm3 (p = 0.628) at the last follow-up. Frontal and occipital horn ratio (FOHR) and third ventricular width statistically decreased over time (p < 0.001 and p < 0.05, respectively). Conclusions The authors' results support existing evidence that tectal plate gliomas frequently follow a benign clinical and radiographic course and rarely require any intervention beyond management of associated hydrocephalus.

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“…One required 2 revisions. Romeo et al [17] performed 27 ETVs in 22 patients. Revisions were needed for 5 patients (23%), which is consistent with our findings.…”

Section: Discussionmentioning

confidence: 99%

Tectal Lesions in Children: A Long-Term Follow-Up Volumetric Tumor Growth Analysis in Surgical and Nonsurgical Cases

Kershenovich

Silman²,

Rungs

et al. 2016

Pediatr Neurosurg

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Background/Aims: Different tectal masses have been described; most are low-grade gliomas. Only 20-30% of all lesions grow, as shown on follow-up MRIs, requiring surgical resection at some point. The aim of this study is to describe the experience of a single institution managing pediatric patients with tectal lesions. Methods: We retrospectively studied and analyzed 40 children with tectal lesions managed from 1990 to 2006; the mean age at diagnosis was 9.4 years. A volumetric classification was used to analyze tumor growth trends. More than 1 year of imaging follow-up was available for 23 patients. Results and Conclusion: Medium- and large-volume-size lesions were associated with the need for surgery. About half of the nonsurgical lesions grew at least 50% over a period of 4.5 years and did not require surgical resection.

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Long-term change in ventricular size following endoscopic third ventriculostomy for hydrocephalus due to tectal plate gliomas

Cited by 22 publications

References 29 publications

Endoscopic third ventriculostomy in children: prospective, multicenter results from the Hydrocephalus Clinical Research Network

Endoscopic third ventriculostomy in children: prospective, multicenter results from the Hydrocephalus Clinical Research Network

Pediatric tectal plate gliomas: clinical and radiological progression, MR imaging characteristics, and management of hydrocephalus

Tectal Lesions in Children: A Long-Term Follow-Up Volumetric Tumor Growth Analysis in Surgical and Nonsurgical Cases

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