The Role of Third Ventriculostomy in the Management of Obstructive Hydrocephalus

Grunert, Peter; Charalampaki, Patra; Hopf, Nikolai J.; Filippi, R.

doi:10.1055/s-2003-37957

Cited by 122 publications

(72 citation statements)

References 22 publications

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“…During the observation period from 1993 to 1999, there was no significant evolution of the surgical technique. For a detailed description of the technique, please refer to Hopf et al 22 or Grunert et al 18 In 23 early ETVs, frame-based stereotactic guidance was used; later, the surgical technique slightly changed and ETVs were performed using frameless navigation and then freehand. This change in surgical technique occurred in accordance with the growing experience of the surgeons, standard entry points, and defined anatomical landmarks.…”

Section: Surgical Techniquementioning

confidence: 99%

Long-term results of endoscopic third ventriculostomy: an outcome analysis

Vulcu

Eickele

Cinalli

et al. 2015

JNS

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T he technique of endoscopic third ventriculostomy (ETV) has been under close evaluation as a treatment option for obstructive hydrocephalus. Although early on the procedure was associated with a very high, unacceptable complication rate, 41 more recent publications have reported success rates of about 70% and low complication rates, including mortality, around 0.5%-1.0%. 9,13,20,31,35 Nowadays, ETV is accepted as the gold standard for treatment of obstructive hydrocephalus. In comparison with ventriculoperitoneal shunting, a significantly lower complication rate and reoperation rate in the long term is expected. 2,10,26 Nevertheless, topics such as the prediction of ETV success, 4,12,26,28,42 period of highest failure rate, 26 and late deterioration after ETV 7,29 are still topics of discussion. However, current data are scarce, and the long-term efficacy of ETV is often under debate, since most studies have reported a rather short follow-up period, e.g., 8 months 13 or a few years. 1,22,23,40 Very few studies exist with a significantly longer follow-up, e.g., 4 years. 35This study investigates very long term success rates, up to 16 years, and the incidence of failures in the early and long-term postoperative periods after ETV. Methods Study DesignThe long-term outcome of ETV was evaluated through a retrospective analysis of all patients who underwent an abbreviatioN ETV = endoscopic third ventriculostomy. SubMitteD February 22, 2014. accepteD November 25, 2014. iNcluDe wheN citiNg Published online July 31, 2015; DOI: 10.3171/2014.11.JNS14414. DiScloSure J. Oertel reports that he is a consultant for Karl Storz Co. The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. obJect Endoscopic third ventriculostomy (ETV) is the procedure of choice in the treatment of obstructive hydrocephalus. The excellent clinical and radiological success rates are well known. Nevertheless, very few papers have addressed the very long term outcomes of the procedure in very large series. The authors present a large case series of 113 patients who underwent 126 ETVs, and they highlight the initial postoperative outcome after 3 months and long-term follow-up with an average of 7 years. MethoDS All patients who underwent ETV at the Department of Neurosurgery, Mainz University Hospital, between 1993 and 1999 were evaluated. Obstructive hydrocephalus was the causative pathology in all cases. reSultS The initial clinical success rate was 82% and decreased slightly to 78% during long-term follow-up. Longterm success was analyzed using Kaplan-Meier curves. Overall, ETV failed in 31 patients. These patients underwent a second ETV or shunt treatment. A positive impact on long-term success was seen for age older than 6 months, and for obstruction due to cysts or benign aqueductal stenosis. The complication rate was 9% with 5 intraoperative and 5 postoperative events. coNcluSioNS The high clinical success rate in short-term and long-term follow-up confirms ETV's s...

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Section: Surgical Techniquementioning

confidence: 99%

Long-term results of endoscopic third ventriculostomy: an outcome analysis

Vulcu

Eickele

Cinalli

et al. 2015

JNS

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“…Many different neuroendoscopic indications have since been described, and reports on successful endoscopic treatments for various pathological entities such as obstructive hydrocephalus of any origin, 1,[4][5][6]8,10,13,17,[21][22][23]25,[29][30][31][32]38,40,42,48,51 arachnoid cysts, 2,7,9,12,20,24,26,28,35,39,46,47,50 septum pellucidum cysts, 14,19,34 and intra-and paraventricular tumors 16,33 have been frequent. Even in rare cystic lesions 18 or idiopathic normal pressure hydrocephalus, 18 successful CSF circulation restoration has been described with endoscopy.…”

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confidence: 99%

Endoscopic options in children: experience with 134 procedures

Oertel

Baldauf

Schroeder

et al. 2009

PED

106

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Object There are frequent applications for endoscopy in neurosurgery. However, endoscopic surgery in children has peculiar characteristics and is associated with different rates of success. In this study, the authors report on their experience with 134 consecutive endoscopy procedures performed in 126 patients < 18 years of age. Methods Between April 1993 and October 2007, 134 endoscopic procedures were performed in 126 children. Indications for surgery included brain tumors in 48 children, cystic lesions in 24, aqueductal stenosis in 23, various malformations in 20, hemorrhage and infarction in 6, and isolated ventricles in 5 children. In this long-term followup study, data were analyzed with respect to clinical and radiological success rates, as well as shunt dependence both in relation to lesion origin, and to the type of endoscopic procedure performed (endoscopic third ventriculostomy [ETV], septostomy, aqueductoplasty, or cystocisternostomy). Finally, the influence of patient age on the success rate was evaluated. Results In 114 patients, restoration of CSF circulation was the goal of endoscopy, but in 2 patients only ventriculoscopy was performed followed by ventriculoperitoneal shunt placement. In 12 of 114 patients, tumor biopsy sampling or resection was performed simultaneously with shunt placement. In another 12 patients, only endoscopic tumor resection without CSF circulation restoration was done. The follow-up period ranged from 1 to 6 years. Thirteen tumor biopsies, 7 partial tumor resections, and 4 endoscopically complete tumor resections were performed. An intraoperative switch to microsurgery was made in 2 patients because of recurrent hemorrhage and an overly time-consuming endoscopic surgery. Cerebrospinal fluid circulation was successfully restored in 81 (72%) of 112 patients, with the use of endoscopy in the setting of tumor-related hydrocephalus providing the best results (86% success rate). However, of the various endoscopic procedures, cyst openings (cystocisternostomy, cystoventriculostomy, and ventriculocystocisternostomy) provided the best results—superior even to ETV—with a success rate of 77% and no complications. In contrast, endoscopic aqueductoplasty had a high failure and complication rate. Patients < 6 months old who underwent ETV, septostomy, or aqueductoplasty had poor results and became more frequently shunt dependent than older children. Conclusions Overall, endoscopy can be considered safe and effective in children. Based on the authors' data, acute hydrocephalus cases such as those caused by tumors are the best candidates for endoscopic CSF flow restoration. Interestingly, cyst openings to the ventricles or cisterns were the most successful endoscopic techniques with the lowest complication rate. Aqueductoplasty should be reserved for selected cases. Finally, the success rate of endoscopic techniques remains poor in infants < 6 months of age; this was not only true of ETV, but also other techniques such as septostomy and aqueductoplasty.

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“…At our institution, endoscopic third ventriculostomy (ETV) remains the mainstay of treatment in the setting of isolated obstructive hydrocephalus. The ETV procedure has shown high rates of success by creating an alternative pathway for CSF to flow (5,7,9,11,15). ETV, however, has a known potential complication of damaging the basilar artery due to the location of the area of fenestration at the floor of the third ventricle; this is especially true when a basilar apex aneurysm is present (1,5,12,14,16,19).…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive treatment of biventricular hydrocephalus caused by a giant basilar apex aneurysm via a staged combination of endoscopy and endovascular embolization: a case report

Setty

Волков²,

Richards³

et al. 2014

Turkish Neurosurgery

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Biventricular hydrocephalus caused by a Giant Basilar Apex Aneurysm (GBAA) is a rare finding that presents unique and challenging treatment decisions. We report a case of GBAA causing a life-threatening biventricular hydrocephalus in which both the aneurysm and hydrocephalus were given definitive treatment through a staged, minimally invasive approach.An obtunded 82-year-old male was found to have biventricular hydrocephalus caused by an unruptured GBAA obstructing the foramina of Monro. The patient was treated via staged, minimally invasive technique that first involved endoscopic fenestration of the septum pellucidum to create communication between the lateral ventricles. A programmable ventriculo-peritoneal shunt was then placed with a high-pressure setting. The patient was then loaded with dual anti-platelet therapy prior to undergoing endovascular coiling of the GBAA with adjacent stenting of the Posterior Cerebral Artery. He remained on dual anti-platelet therapy and the shunt setting was lowered at the bedside to treat the hydrocephalus. At 6-month follow up, the patient had returned to his cognitive baseline, speaking fluently and appropriately.Biventricular hydrocephalus caused by a GBAA can successfully be treated in a minimally invasive fashion utilizing a combination of endoscopy and endovascular therapy, even when a stent-assisted coiling is needed. KEywoRds: Coil embolization, Endoscopy, Endovascular, Giant aneurysm, Obstructive hydrocephalus ÖZDev Baziller Apeks Anevrizmasının (GBAA) neden olduğu biventriküler hidrosefali nadir bir bulgudur. Tedavi kararları eşsiz ve zordur. Hem anevrizma hem hidrosefalinin, minimal invaziv yaklaşımla kademeli olarak kesin tedavi edildiği; yaşamı tehdit edici bir biventriküler hidrosefaliye neden olan GBAA olgusu sunuldu.Zihinsel olarak donuk, 82 yaşında bir erkekte, Monro foramenini tıkayan rüptüre olmamış bir GBAA nedeniyle biventriküler hidrosefali bulundu. Hasta kademeli, minimal invaziv bir teknikle tedavi edildi ve önce lateral ventriküller arasında geçiş oluşturmak üzere septum pellusidumun endoskopik fenestrasyonu yapıldı. Sonra yüksek basınçlı ortamda programlanabilir bir ventriküloperitoneal şant yerleştirildi. GBAA'ya endovasküler sarmal yerleştirme ve yanında posterior serebral artere stent konulması öncesinde hastaya ikili antitrombosit tedavi yüklendi. İkili antitrombosit tedaviye devam edildi ve hidrosefaliyi tedavi etmek üzere şant ayarı yatak yanında azaltıldı. 6 aylık takipte hasta kognitif olarak başlangıç durumuna dönmüştü ve akıcı ve uygun bir şekilde konuşuyordu.GBAA'nın neden olduğu biventriküler hidrosefali, stent yardımlı sarmal yerleştirilmesi gerektiği zaman bile, endoskopi ve endovasküler tedavinin bir kombinasyonu kullanılarak minimal invaziv şekilde başarıyla tedavi edilebilir.

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The Role of Third Ventriculostomy in the Management of Obstructive Hydrocephalus

Cited by 122 publications

References 22 publications

Long-term results of endoscopic third ventriculostomy: an outcome analysis

Long-term results of endoscopic third ventriculostomy: an outcome analysis

Endoscopic options in children: experience with 134 procedures

Minimally invasive treatment of biventricular hydrocephalus caused by a giant basilar apex aneurysm via a staged combination of endoscopy and endovascular embolization: a case report

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