Effect of endoscopic third ventriculostomy on cerebrospinal fluid pressure in the cerebral ventricles

Farnoush, A.; Tan, Kristy; Jugé, Lauriane; Bilston, Lynne E.

doi:10.1016/j.jocn.2015.04.025

Cited by 9 publications

(4 citation statements)

References 22 publications

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“…The entirety of this mechanism is not well understood, but the general principle involves the brain parenchyma becoming sensitive to changes within the ventricular system caused by over- or underdrainage as regulated by the shunt, because the shunt cannot biomechanically regulate CSF dynamics as naturally as an ETV, 1 which helps to facilitate translocation of CSF out of the ventricular system during the cardiac cycle. 14 This concept is demonstrated in our patient in case 7, who presented multiple times with symptoms and radiographic evidence of both over- and underdrainage despite a patent VPS and multiple attempts at optimizing his shunt and antisiphon settings. Ultimately, he required an ETV along with his VPS.…”

Section: Discussionmentioning

confidence: 68%

Endoscopic third ventriculostomy in hydrocephalus patients with functioning ventriculoperitoneal shunts: challenging the dictum that shunts treat all types of hydrocephalus. Patient series

Rainone,

Woodhouse,

Kramer

et al. 2024

Journal of Neurosurgery: Case Lessons

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BACKGROUND Although ventriculoperitoneal shunting is standard for hydrocephalus, shunting may not be ideal for aqueductal stenosis. A cohort of patients with aqueductal stenosis displayed symptoms of over- and underdrainage, despite a patent ventriculoperitoneal shunt (VPS) and optimized valve settings. Endoscopic third ventriculostomies (ETVs) were performed in a subset of these patients with successful treatment of their underlying hydrocephalus, despite a functioning shunt. OBSERVATIONS All patients who had undergone ETV with a history of ventriculoperitoneal shunting were retrospectively reviewed. Patients experiencing over- or underdrainage symptoms despite a patent shunt were included. Cerebral aqueduct anatomy and third ventricle bowing were reviewed on preoperative imaging. Seven patients met the study criteria. All showed cerebral aqueductal stenosis and third ventricle bowing. After ETV, all patients demonstrated decreased third ventricle bowing and clinical improvement without the need for secondary cerebrospinal fluid (CSF) diversion. LESSONS Despite a functioning VPS, patients with aqueductal stenosis may not be adequately treated. The underlying reasons are not clearly understood but suggest abnormal CSF dynamics due to aberrant parenchymal compliance. The authors theorize that ETV can more effectively treat these patients. ETV can be considered a viable treatment option in aqueductal stenosis despite a patent VPS, challenging the traditional teaching that shunts ideally treat all types of hydrocephalus.

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Section: Discussionmentioning

confidence: 68%

Endoscopic third ventriculostomy in hydrocephalus patients with functioning ventriculoperitoneal shunts: challenging the dictum that shunts treat all types of hydrocephalus. Patient series

Rainone,

Woodhouse,

Kramer

et al. 2024

Journal of Neurosurgery: Case Lessons

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“…A computational modeling study of hydrocephalus found that the peak caudal velocity occurred later in the cardiac cycle after a simulated endoscopic third ventriculostomy at the third ventricle. 19 There were several limitations to this study. First, the primary motivation of this research was to understand CSF flow velocity above and below the syrinx in posttraumatic patients.…”

Section: Discussionmentioning

confidence: 94%

Characteristics of CSF Velocity-Time Profile in Posttraumatic Syringomyelia

Yeo¹,

Hemley²,

Lee³

et al. 2017

AJNR Am J Neuroradiol

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“…Farnoush et al (2016) studied CSF flow velocity simulation in AS and imposed pressure in the third ventricle, with and without ETV. After ETV operation, CSF flow velocity peak in Sylvius aqueduct and peak positive pressure decreased 5 and 9 times, respectively.…”

Section: Comparing Changes Of Csf Hydrodynamics In Etv and Vpsmentioning

confidence: 99%

“…Using ETV reduced AS velocity up to 16–17 cm/s. ETV effectiveness depends on AS level in the CSF circulation path (Farnoush et al, 2016).…”

Section: Comparing Changes Of Csf Hydrodynamics In Etv and Vpsmentioning

confidence: 99%

Hydrocephalus and Comparing the Efficiency of two Treatment Methods: Shunt Implantation and Endoscopic third Ventriculostomy

Gholampour

Bahmani

Shariati

2018

Basic Clin. Neurosci. J.

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Introduction: Hydrocephalus is one of the most common diseases in children, and its treatment requires brain operation. However, the pathophysiology of the disease is very complicated and still unknown. Methods: Endoscopic Third Ventriculostomy (ETV) and Ventriculoperitoneal Shunt (VPS) implantation are among the common treatments of hydrocephalus. In this study, Cerebrospinal Fluid (CSF) hydrodynamic parameters and efficiency of the treatment methods were compared with numerical simulation and clinical follow-up of the treated patients. Results: Studies have shown that in patients under 19 years of age suffering from hydrocephalus related to a Posterior Fossa Brain Tumor (PFBT), the cumulative failure rate was 21% and 29% in ETV and VPS operation, respectively. At first, the ETV survival curve shows a sharp decrease and after two months it gets fixed while VPS curve makes a gradual decrease and reaches to a level lower than ETV curve after 5.7 months. Post-operative complications in ETV and VPS methods are 17% and 31%, respectively. In infants younger than 12 months with hydrocephalus due to congenital Aqueduct Stenosis (AS), and also in the elderly patients suffering from Normal Pressure Hydrocephalus (NPH), ETV is a better treatment option. Computer simulations show that the maximum CSF pressure is the most reliable hydrodynamic index for the evaluation of the treatment efficacy in these patients. After treatment by ETV and shunt methods, CSF pressure decreases about 9 and 5.3 times, respectively and 2.5 years after shunt implantation, this number returns to normal range. Conclusion: In infants with hydrocephalus, initial treatment by ETV was more reasonable than implanting the shunt. In adult with hydrocephalus, the initial failure in ETV occurred sooner compared to shunt therapy; however, ETV was more efficient.

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Effect of endoscopic third ventriculostomy on cerebrospinal fluid pressure in the cerebral ventricles

Cited by 9 publications

References 22 publications

Endoscopic third ventriculostomy in hydrocephalus patients with functioning ventriculoperitoneal shunts: challenging the dictum that shunts treat all types of hydrocephalus. Patient series

Endoscopic third ventriculostomy in hydrocephalus patients with functioning ventriculoperitoneal shunts: challenging the dictum that shunts treat all types of hydrocephalus. Patient series

Characteristics of CSF Velocity-Time Profile in Posttraumatic Syringomyelia

Hydrocephalus and Comparing the Efficiency of two Treatment Methods: Shunt Implantation and Endoscopic third Ventriculostomy

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