Risk Factors for Failure of Endoscopic Third Ventriculostomy for Obstructive Hydrocephalus

Fukuhara, Toru; Vorster, Sarel J.; Luciano, Mark

doi:10.1097/00006123-200005000-00015

Cited by 237 publications

(155 citation statements)

References 33 publications

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“…[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.…”

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

Xiao

Ragab

Luciano

2009

Can. j. neurol. sci.

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“…In these series cine MR imaging was only performed later than 1 year after ETV when there were symptoms of failure. Fukuhara and colleagues 7,8 used cine MR images to confirm an obstruction of the stoma, but only considered a cine MR imaging finding of obstruction diagnostic when the patients presented with signs of intracranial hypertension.…”

Section: Discussionmentioning

confidence: 99%

Long-term operative failure of endoscopic third ventriculostomy in pediatric patients: the role of cine phase-contrast MR imaging

Faggin

Calderone²,

Denaro

et al. 2011

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Object Although a rarely reported occurrence, late failure of endoscopic third ventriculostomy (ETV) may occur in children as a result of a variety of factors. Delay in recognition of symptoms can lead to harmful deterioration in the patient's condition. The authors undertook this study to assess the capacity of cine phase-contrast MR imaging to identify late failure in asymptomatic pediatric patients treated with ETV for hydrocephalus. Methods This study was a retrospective evaluation of cases involving patients who underwent ETV between January 1, 1999, and December 31, 2008, at the pediatric neurological surgery service of the University of Padua. Before 2004, patients were routinely followed up with cine MR imaging at 3, 6, and 12 months after ETV. In 2004, a protocol of annual cine MR follow-up was instituted as a result of a case of fatal late failure. The authors evaluated all cases of late failure identified through cine MR imaging and performed a statistical analysis to investigate the relationship between ETV failure and several variables, including the cause of hydrocephalus for which ETV was originally indicated. Results In a series of 84 patients (age range 6 days–16 years), 17 patients had early ETV failure. Of the remaining 67 patients, 5 (7%) were found to have no CSF flow through the fenestration and recurrent ventriculomegaly when assessed with cine MR imaging at 1, 2, 3, 4, and 7 years after ETV. The patient in whom ETV failure was identified 1 year postoperatively had Dandy-Walker malformation. The patients in whom ETV failure was identified 2, 3, and 4 years postoperatively all had undergone ETV for treatment of postinfective hydrocephalus. The patient in whom ETV failure was identified 7 years postoperatively had a cystic arachnopathy in the fourth ventricle after cerebellar astrocytoma removal. Conclusions Patients who undergo ETV for infective hydrocephalus and Dandy-Walker malformation should receive long-term follow-up, because late closure of the stoma may occur progressively and slowly. Intraoperative observation of thickened arachnoid membranes at the level of the interpeduncular cisterns at the first ETV and a progressive decreasing of CSF flow through the stoma on routine cine MR imaging should be considered unfavorable elements entailing a significant risk of deterioration.

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“…14,21,22,28,36,44) Subdural hygromas or effusions, which are not genuine subdural hematomas, may occur after shunting procedures or other neurosurgical interventions, but are usually absorbed postoperatively without evolution, unless infection or bleeding complications are present, and do not require surgical intervention. Hygromas usually have a benign course even as a post-shunt phenomenon, and will not need surgical treatment.…”

Section: Discussionmentioning

confidence: 99%

“…3,7,14,16,17,25,30,40,43,46) Furthermore, injuries of vessels may cause various forms of minor or major hemorrhage (subarachnoid, intraventricular, and intracerebral). However, only three cases of subdural hematoma or hygroma after neuroendoscopic procedures have been reported.…”

Section: Introductionmentioning

confidence: 99%

Subdural Hygroma as a Complication of Endoscopic Neurosurgery. Two Case Reports.

Freudenstein

Wagner

Ernemann

et al. 2002

Neurol. Med. Chir.(Tokyo)

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Two cases of subdural hygroma occurred in a series of 77 neuroendoscopic procedures. An 8-year-old boy underwent neuroendoscopic cysto-cisternostomy of a left temporal arachnoid cyst. Routine postoperative magnetic resonance imaging 7 days later showed a large left-sided subdural hygroma without clinical symptoms. During the following 3 months, the subdural hygroma did not resolve spontaneously, so it was drained through a burr hole. A 3-month-old boy with aqueductal stenosis developed bilateral subdural hygromas after third ventriculostomy. Several punctures through the open anterior fontanelle relieved the hygromas but increasing head circumference required ventriculoperitoneal shunting 12 months later. Complications of neuroendoscopic procedures are increasingly reported, including various kinds of bleeding, infections, or damage of neuronal tissue. Only three previous cases of subdural hygroma or hematoma after neuroendoscopic interventions have been reported. The possible etiologies and clinical consequences of this rare complication have to be considered before selecting neuroendoscopy treatment.

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Risk Factors for Failure of Endoscopic Third Ventriculostomy for Obstructive Hydrocephalus

Abstract: The risk of failure increases with intracerebral infection, likely because of obliteration of cerebrospinal fluid pathways.

Cited by 237 publications

References 33 publications

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

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

Long-term operative failure of endoscopic third ventriculostomy in pediatric patients: the role of cine phase-contrast MR imaging

Subdural Hygroma as a Complication of Endoscopic Neurosurgery. Two Case Reports.

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