Management of Hydrocephalus by Endoscopic Third Ventriculostomy in Patients with Myelomeningocele

Teo, Charles; Jones, Robert

doi:10.1159/000121098

Cited by 266 publications

(165 citation statements)

References 13 publications

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“…The complication rate of 11% encountered in this study fits well within the 6 to 20% range of complication rates reported in the literature (17). Although several serious and fatal complications have been reported including intraoperative venous or arterial bleeding, seizures, CSF leakage, infection, oculomotor nerve palsy, bradycardia, temperature regulation disturbance, diabetes insipidus, syndrome of inappropriate antidiuretic hormone, basilar artery perforation or traumatic aneurysm, subarachnoid, and subdural hematoma (2, 3,4,10,11,14,23,25), the complications of ETV in the majority of cases are usually clinically insignificant.…”

Section: A B C Azab W Et Al: Preoperative Endoscopic Third Ventriculsupporting

confidence: 84%

Preoperative endoscopic third ventriculostomy in children with posterior fossa tumors: an institution experience

Azab¹,

Alsheikh²,

Yahia³

2012

Turkish Neurosurgery

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AIm:To assess the effectiveness and safety of pre-resection endoscopic third ventriculostomy (ETV) in permanently relieving hydrocephalus in children with posterior fossa tumors. mAterIAl and methOds: 17 pediatric patients with posterior fossa tumors and associated triventricular obstructive hydrocephalus underwent ETV before definitive tumor resection, and ETV was repeated after tumor resection if hydrocephalus with increased intracranial pressure persisted or recurred. The medical records, operative notes and imaging studies were retrospectively reviewed.results: 18 ETV procedures were performed in 17 patients, consisting of 11 males and 6 females, age range (1.5 to 13 years; mean 6±3.86). Follow-up periods ranged from 6 to 23 months (mean follow-up 13.9±5.4 months). ETV was successful in relieving hydrocephalus during the follow-up period in 15 out of 17 patients (88.2%). Prior to surgical excision of the posterior fossa tumors, no failures of ETV were detected and all of the 17 patients showed marked clinical improvement and radiological disappearance of signs of active hydrocephalus.COnClusIOn: Preoperative ETV is a highly effective long-term CSF diversion procedure for treatment of hydrocephalus associated with posterior fossa tumors in children. In experienced hands, ETV has a very low complication rate.KeywOrds: Hydrocephalus, Endoscopic third ventriculostomy, Posterior fossa tumor ÖZ AmAÇ: Posterior fossa tümörlü çocuklarda hidrosefaliyi kalıcı olarak tedavi etmek üzere rezeksiyon öncesi endoskopik üçüncü ventrikülosto-minin (ETV) etkinlik ve güvenliğini değerlendirme. yÖntem ve GereÇler: Posterior fossa tümörlü ve ilişkili triventriküler obstrüktif hidrosefalili 17 pediatrik hastada kesin tümör rezeksiyonu öncesinde ETV yapıldı ve ETV işlemi eğer artmış intrakraniyal basınçlı hidrosefali devam ediyorsa veya tekrarlarsa tümör rezeksiyonu sonrasında tekrarlandı. Tıbbi kayıtlar, ameliyat notları ve görüntüleme çalışmaları retrospektif olarak gözden geçirildi.BulGulAr: Yaş aralığı 1,5-13 yıl (ortalama 6±3,86) olan ve 11 erkek ve 6 kadından oluşan 17 hastada 18 ETV işlemi yapıldı. Takip dönemleri 6 ile 23 ay arasındaydı (ortalama takip 13,9±5,4 ay). ETV, takip döneminde 17 hastanın 15'inde (%88,2) hidrosefaliyi tedavi etmekte başarılıydı. Posterior fossa tümörlerinin cerrahi insizyonu öncesinde herhangi bir ETV başarısızlığı saptanmadı ve 17 hastanın tümünde belirgin klinik iyileşme ve aktif hidrosefali bulgularının radyolojik olarak kaybolması görüldü. sOnuÇ: Preoperatif ETV çocuklarda posterior fossa tümörleriyle ilişkili hidrosefalinin tedavisinde çok etkin, uzun dönemli bir BOS dİversiyonu işlemidir. Deneyimli ellerde, ETV'nin komplikasyon oranı çok düşüktür AnAhtAr sÖZCÜKler: Hidrosefali, Endoskopik üçüncü ventrikülostomi, Posterior fossa tümörü

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Section: A B C Azab W Et Al: Preoperative Endoscopic Third Ventriculsupporting

confidence: 84%

Preoperative endoscopic third ventriculostomy in children with posterior fossa tumors: an institution experience

Azab¹,

Alsheikh²,

Yahia³

2012

Turkish Neurosurgery

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“…6,15,16 This is particularly true in cases in which the hydrocephalus is induced by a mechanical obstruction within the lumen of the aqueduct, such as septations or membranes, or by an extrinsic compression due to a tumor of the tectal plate or pineal gland or posterior fossa tumors, without any additional obstacle in the CSF pathways distal to the obstruction. 15,[17][18][19] By forming a communication between the third ventricle and the subarachnoid space, an almost normal physiological CSF circulation should be restored. Basal cisterns are crucial passageways between supra-and infra-tentorial subarachnoid space, and CMJ provides a vehicle for communication between cranial and spinal fluid for final CSF absorption.…”

Section: Discussionmentioning

confidence: 99%

Cine Phase-Contrast MR Images Failed to Predict Clinical Outcome Following ETV

Xiao

Ragab

Luciano

2009

Can. j. neurol. sci.

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Endoscopic third ventriculostomy (ETV) has been a popular surgical option for obstructive hydrocephalus (OHCP) in recent decades. [1][2][3] A number of studies worldwide have reported favorable outcomes; 4-6 however, in some cases, ETV fails to resolve symptoms, even when it is technically successful with adequate patent stoma and fenestrated Lillequist membrane. [7][8][9][10][11] It has been hypothesized that patients might suffer from hydrocephalus caused by other obstructive membranes or by fibrosis in the subarachnoid space, especially around basal cisterns. Cine phase-contrast magnetic resonance imaging (PC MR) has been utilized as a method of distinguishing between ABSTRACT: Background: To predict success of endoscopic third ventriculostomy (ETV) in patients with obstructive hydrocephalus, we evaluated pre-and post-operative phase-contrast cine magnetic resonance images (PC MRI) on cerebrospinal fluid (CSF), cine flow in basal cisterns around the brain stem, and cervical medullar junction (CMJ) retrospectively. Methods: The study involved 102 patients with mean age of 36.74±23.25, and F/M = 1.55. All patients had PC MRI taken both pre-and post-operatively. A dynamic MRI video of PC MRI was reviewed at sagittal, axial, and coronal sections to determine cistern flows around the brain stem and CMJ. For quantitative analysis, quadrants were divided around midbrain axially to evaluate interpeduncular, quadrageminal, and ambient cisterns of both sides using scores of 0 to 60. Pre-and post-pontine and CMJ flows were shown in sagittal view and scored 0 to 20, and lateral cerebellopontine cisterns of both sides were measured on coronal image and scored 0 to 20. Results: No significant difference in CSF flow was seen from three individual views and total cine score, or between ETV success and failure groups by multivariate analysis of variance. Kaplan-Meier Analysis and Spearman's Correlation Test produced no relationship between MRI cine flow scores and interval period after surgery to ETV failure. Conclusion: PC MRI cine flow failed to demonstrate significant differences between successful and failed ETV groups. This indicates in addition to achieving an adequate fenestration, CSF pathways beyond the basal cisterns around the brain stem and CMJ may play an essential role in achieving ETV success. Aucune différence significative du flux du LCR n'a été observée sur trois clichés individuels et l'analyse de variance multivariée n'a décelé aucune différence significative du score ciné total ou entre les groupes dont la VET a été un succès ou un échec. Le test de Kaplan-Meier et le test de corrélation de Spearman n'ont pas montré de relation entre les scores du flux au ciné IRM et l'intervalle entre la chirurgie ou entre les scores et l'échec de la VET. Conclusion : Le ciné IRM CP du flux n'a pas montré de différence significative entre le groupe dont la VET a été un succès et le groupe dont la VET a été un échec. Ceci indique qu'en plus de réussir à établir une fenestration adéquate, les voies du LCR au-delà des citer...

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“…reported for patients with post-infectious hydrocephalus and for post-haemorrhagic patients with prior ventriculo-peritoneal shunt (VPS) failures [28,29,[31][32][33]. This procedure is considered less effective in paediatric populations, although the minimum age for the procedure remains controversial [9,26,28,29,[34][35][36].…”

Section: Introductionmentioning

confidence: 99%

Endoscopic third ventriculostomy in the management of hydrocephalus: Outcome analysis of 168 consecutive procedures

Salvador

Oliveira

Pereira

et al. 2014

Clinical Neurology and Neurosurgery

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a b s t r a c tBackground: Endoscopic third ventriculostomy (ETV) is the treatment of choice for obstructive hydrocephalus, but the outcome is still controversial in terms of age and aetiology. Methods: Between 1998 and 2011, 168 consecutive procedures were performed in 164 patients, primarily children (56% < 18 years of age and 35% < 2 years of age). The causes of obstructive hydrocephalus included tumoural pathology, Chiari malformation, congenital obstruction of the aqueduct, post-infectious and post-haemorrhagic membranes, and ventriculo-peritoneal shunt (VPS) malfunctions. Successful ETV was defined by the resolution of symptoms and the avoidance of a shunt. Results: ETV was successful in 75.6% of patients, but 19% of the patients required VPS in the first month after ETV, and 5.4% required a VPS more than one month after ETV. Four patients were ultimately submitted for second ETVs. In this series, no major permanent morbidity or mortality was observed. Conclusions: ETV is a safe procedure and an effective treatment for obstructive hydrocephalus even following the dysfunction of previous VPSs and in children younger than two years.

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Management of Hydrocephalus by Endoscopic Third Ventriculostomy in Patients with Myelomeningocele

Cited by 266 publications

References 13 publications

Preoperative endoscopic third ventriculostomy in children with posterior fossa tumors: an institution experience

Preoperative endoscopic third ventriculostomy in children with posterior fossa tumors: an institution experience

Cine Phase-Contrast MR Images Failed to Predict Clinical Outcome Following ETV

Endoscopic third ventriculostomy in the management of hydrocephalus: Outcome analysis of 168 consecutive procedures

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