Redo Third Ventriculostomy

Hellwig, Dieter; Giordano, Mario; Kappus, Christoph

doi:10.1016/j.wneu.2012.02.006

Cited by 32 publications

(20 citation statements)

References 45 publications

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“…5,43,44,50,56 In other reports with fewer patients, the success rates range from 0% to 100%. 21,23,26,28,31,33,34,48,53,60,64 Whereas some conclude that re-ETV should be considered in all patients who are referred with recurrent symptoms, others mention that re-ETV remains controversial. We think it is worthwhile to give ETV another chance in selected patients.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic third ventriculostomy and repeat endoscopic third ventriculostomy in pediatric patients: the Dutch experience

Breimer

Dammers

Woerdeman

et al. 2017

Journal of Neurosurgery: Pediatrics

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OBJECTIVEAfter endoscopic third ventriculostomy (ETV), some patients develop recurrent symptoms of hydrocephalus. The optimal treatment for these patients is not clear: repeat ETV (re-ETV) or CSF shunting. The goals of the study were to assess the effectiveness of re-ETV relative to initial ETV in pediatric patients and validate the ETV success score (ETVSS) for re-ETV.METHODSRetrospective data of 624 ETV and 93 re-ETV procedures were collected from 6 neurosurgical centers in the Netherlands (1998–2015). Multivariable Cox proportional hazards modeling was used to provide an adjusted estimate of the hazard ratio for re-ETV failure relative to ETV failure. The correlation coefficient between ETVSS and the chance of re-ETV success was calculated using Kendall’s tau coefficient. Model discrimination was quantified using the c-statistic. The effects of intraoperative findings and management on re-ETV success were also analyzed.RESULTSThe hazard ratio for re-ETV failure relative to ETV failure was 1.23 (95% CI 0.90–1.69; p = 0.20). At 6 months, the success rates for both ETV and re-ETV were 68%. ETVSS was significantly related to the chances of re-ETV success (τ = 0.37; 95% bias corrected and accelerated CI 0.21–0.52; p < 0.001). The c-statistic was 0.74 (95% CI 0.64–0.85). The presence of prepontine arachnoid membranes and use of an external ventricular drain (EVD) were negatively associated with treatment success, with ORs of 4.0 (95% CI 1.5–10.5) and 9.7 (95% CI 3.4–27.8), respectively.CONCLUSIONSRe-ETV seems to be as safe and effective as initial ETV. ETVSS adequately predicts the chance of successful re-ETV. The presence of prepontine arachnoid membranes and the use of EVD negatively influence the chance of success.

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Section: Discussionmentioning

confidence: 99%

Endoscopic third ventriculostomy and repeat endoscopic third ventriculostomy in pediatric patients: the Dutch experience

Breimer

Dammers

Woerdeman

et al. 2017

Journal of Neurosurgery: Pediatrics

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“…[2][3][4][5][6][7] Of the 2 reports involving more than 20 patients (the majority with "obstructive" causes of hydrocephalus), the reported success rates for repeat ETV were 75% (of 40 patients) 5 and 89% (of 32 patients). 3 Peretta and coauthors found subarachnoid adhesions in the cisterns below the floor, as opposed to simple stoma closure, to be a significant negative prognostic factor.…”

Section: Discussionmentioning

confidence: 99%

“…Thus far, results for repeat ETV have been reported in small numbers of patients. [2][3][4][5][6][7] To develop guidelines for deciding when to attempt a repeat ETV we needed to know what the efficacy was for this approach as well as any factors that help determine the outcome. In this paper we provide an analysis of repeat ETV efficacy in the largest number of children reported to date, and identify factors that influenced the outcome.…”

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confidence: 99%

Reopening of an obstructed third ventriculostomy: long-term success and factors affecting outcome in 215 infants

Marano

Stone

Mugamba

et al. 2015

PED

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OBJECT The role of reopening an obstructed endoscopic third ventriculostomy (ETV) as treatment for ETV failure is not well defined. The authors studied 215 children with ETV closure who underwent successful repeat ETV to determine the indications, long-term success, and factors affecting outcome. METHODS The authors retrospectively reviewed the CURE Children's Hospital of Uganda database from August 2001 through December 2012, identifying 215 children with failed ETV (with or without prior choroid plexus cauterization [CPC]) who underwent reopening of an obstructed ETV stoma. Treatment survival according to sex, age at first and second operation, time to failure of first operation, etiology of hydrocephalus, prior CPC, and mode of ETV obstruction (simple stoma closure, second membrane, or cisternal obstruction from arachnoid scarring) were assessed using the Kaplan-Meier survival method. Survival differences among groups were assessed using log-rank and Wilcoxon methods and a Cox proportional hazards model. RESULTS There were 125 boys and 90 girls with mean and median ages of 229 and 92 days, respectively, at the initial ETV. Mean and median ages at repeat ETV were 347 and 180 days, respectively. Postinfectious hydrocephalus (PIH) was the etiology in 126 patients, and nonpostinfectious hydrocephalus (NPIH) in 89. Overall estimated 7-year success for repeat ETV was 51%. Sex (p = 0.46, log-rank test; p = 0.54, Wilcoxon test), age (< vs > 6 months) at initial or repeat ETV (p = 0.08 initial, p = 0.13 repeat; log-rank test), and type of ETV obstruction (p = 0.61, log-rank test) did not affect outcome for repeat ETV (p values ≥ 0.05, Cox regression). Those with a longer time to failure of initial ETV (> 6 months 91%, 3–6 months 60%, < 3 months 42%, p < 0.01; log-rank test), postinfectious etiology (PIH 58% vs NPIH 42%, p = 0.02; log-rank and Wilcoxon tests) and prior CPC (p = 0.03, log-rank and Wilcoxon tests) had significantly better outcome. CONCLUSIONS Repeat ETV was successful in half of the patients overall, and was more successful in association with later failures, prior CPC, and PIH. Obstruction of the original ETV by secondary arachnoid scarring was not a negative prognostic factor, and should not discourage the surgeon from proceeding. Repeat ETV may be a more durable solution to failed ETV/CPC than shunt placement in this context, especially for failures at more than 3 months after the initial ETV. Some ETV closures may result from an inflammatory response that is less robust at the second operation.

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“…In the former setting, patients may benefit from a reopening of the third ventricular floor, or "redo ETV." The success of redo ETV following primary ETV has been documented [36,37] ; however, until recently, the utility of redo ETV following ETV/CPC was unknown. In 2015, Marano et al [38] reported a 51% 7-year success rate of redo ETV in a series of 215 patients originally treated with ETV/CPC.…”

Section: Etv/cpc Failures Complications and Redo Operationsmentioning

confidence: 99%

The Global Rise of Endoscopic Third Ventriculostomy with Choroid Plexus Cauterization in Pediatric Hydrocephalus

Dewan

Naftel²

2016

Pediatr Neurosurg

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In the quest to identify the optimal means of cerebrospinal fluid diversion free of shunt dependency, endoscopic third ventriculostomy (ETV) with choroid plexus cauterization (CPC) has been proposed as a promising procedure in select children. Supplementing traditional ETV with obliteration of the choroid plexus has been shown to decrease the likelihood of ultimate shunt dependency by roughly 20%. Originally devised to treat hydrocephalus in infants in sub-Saharan Africa, ETV/CPC has gained eager attention and cautious support in the developed world. Herein, we offer a comprehensive review of ETV/CPC beginning with the history and theory behind the operation. Next, we delve into the data supporting its use across heterogeneous pediatric populations, and finally we discuss clinical outcomes and future directions.

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Redo Third Ventriculostomy

Cited by 32 publications

References 45 publications

Endoscopic third ventriculostomy and repeat endoscopic third ventriculostomy in pediatric patients: the Dutch experience

Endoscopic third ventriculostomy and repeat endoscopic third ventriculostomy in pediatric patients: the Dutch experience

Reopening of an obstructed third ventriculostomy: long-term success and factors affecting outcome in 215 infants

The Global Rise of Endoscopic Third Ventriculostomy with Choroid Plexus Cauterization in Pediatric Hydrocephalus

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