Elastance Correlates with Outcome after Endoscopic Third Ventriculostomy in Adults with Hydrocephalus Caused by Primary Aqueductal Stenosis

Tisell, Magnus; Edsbagge, Mikael; Stephensen, Hannes; Czosnyka, Marek; Wikkelsø, Carsten

doi:10.1097/00006123-200201000-00013

Cited by 48 publications

(67 citation statements)

References 39 publications

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“…There were 52 cases out of the 258 (20%) cases of hydrocephalus that had aqueductal stenosis as a cause of hydrocephalus, with a rate off 9.6% having congenital aqueductal stenosis and rate of 10% in adults. This is lower compared to reported cases of 30-40% with a varying prevalence of 15-60% of hydrocephalus in children and 10-40% of cases in adults [7, 8]. There was a bimodal distribution seen with age with one peak being before the age of 1 years and the second peak being after 12 years which compares with previously documented data [9].…”

Section: Discussioncontrasting

confidence: 63%

Clinical analysis of aqueductal stenosis in patients with hydrocephalus in a Kenyan setting

Kaur¹,

Munyiri²,

Dismus³

2017

Pan Afr Med J

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IntroductionAqueductal stenosis is the commonest cause of congenital hydrocephalus. The scope of this paper is to highlight the disease burden of hydrocephalus attributed to aqueductal stenosis which still remains unknown in our setting.MethodsIn a descriptive cross-sectional study, 258 records of patients diagnosed with hydrocephalus were analyzed after ethical approval from Kenyatta National Hospital- University of Nairobi (KNH-UON) ethics and research committee from January 2010 to May 2016. Patients with a diagnosis of hydrocephalus due to aqueductal stenosis were included in this study. Patients age, sex, mode of delivery, associated comorbidities, presenting complaints, neurosurgical intervention performed, Kafarnosky score were recorded. Data were divided into 2 sets based on the patient's age i.e. whether < 1 year or > 12 years. Data were recorded on google data collection form and analyzed using Google spreadsheets.ResultsOut of 258 cases of hydrocephalus, 52 had aqueductal stenosis. Male to female sex ratio for this condition was 3:2. There were 25 cases < 1year and 27 cases > 12 years old who were diagnosed with hydrocephalus due to aqueductal stenosis. Associated conditions were bilateral congenital talipes equinovarus, spina bifida, Arnold Chairi malformations, meningitis and HIV. The presenting complaints differed according to the age groups. Neurosurgical interventions included Endoscopic Third Ventriculostomy (ETV) in 21 cases, insertion of Ventriculoperitoneal (VP) shunt and ETV were done in 3 cases while the rest had only insertion of VP shunt. The Kafanosky score improve from < 50 pre-op to 19 cases achieving a score of 100, six months post-op.ConclusionAqueductal stenosis contributes a significant burden of morbidity in patients with hydrocephalus. Clinical presentation differs according to patients age. Accurate diagnosis and treatment remain a cardinal to improving patient outcome.

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Section: Discussioncontrasting

confidence: 63%

Clinical analysis of aqueductal stenosis in patients with hydrocephalus in a Kenyan setting

Kaur¹,

Munyiri²,

Dismus³

2017

Pan Afr Med J

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“…Shunting of the CSF from the ventricular system to the peritoneum or the right atrium is the primary treatment for 80% of the hydrocephalic adults with communicating hydrocephalus and might also be secondary treatment for those patients with non-communicating hydrocephalus who do not improve after endoscopic third ventriculostomy 2. Postoperative complications include infection, obstruction, subdural fluid collection, seizures, overdrainage headache and shunt underdrainage 3…”

mentioning

confidence: 99%

Perioperative risk factors for short term shunt revisions in adult hydrocephalus patients

Farahmand

Hilmarsson

Högfeldt

et al. 2009

Journal of Neurology, Neurosurgery & Psychiatry

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“…Unsere diesbezüglichen Erfahrungen stehen im Widerspruch zu den Ergebnissen von Tisell u. Mitarb. [26] bei ebenfalls 15 Patienten. Die vorgenannten Autoren [26] fanden keine Korrelation zwischen ventrikulär gemessenen pathologischen Abflusswiderständen und dem Outcome nach Ventrikulostomie.…”

Section: Diskussionunclassified

“…[26] bei ebenfalls 15 Patienten. Die vorgenannten Autoren [26] fanden keine Korrelation zwischen ventrikulär gemessenen pathologischen Abflusswiderständen und dem Outcome nach Ventrikulostomie. Hingegen korrelierten die Reduktion der Abflusswiderstände nach Ventrikulostomie, die präoperative Compliance und die postoperative Reduktion der Ventrikelgröûen positiv mit dem klinischen Krankheitsverlauf.…”

Section: Diskussionunclassified

“…Der im Vergleich zu unserem Patientengut (2 Patienten, 13 %) gröûere Anteil (6 Patienten, 40 %) mit sekundärer Shunt-Operation wegen fortbestehender Symptomatik nach Ventrikulostomie bei Tisell u. Mitarb. [26] verdeutlicht unserer Meinung nach die Notwendigkeit der lumbalen Untersuchungstechnik vor dem ventrikulären Infusionstest um Störungen der Liquorresorption insbesondere im Bereich der Granulationes arachnoidales zu identifizieren und diejenigen Patienten primär einer Ventil-Operation zuzuführen. [25].…”

Section: Diskussionunclassified

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Shunt-Operation versus endoskopische Ventrikulostomie beim Normaldruckhydrozephalus: Diagnostik und Outcome

Meier

2003

Zentralbl Neurochir

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In contrast to shunt operation the indication for an endoscopic ventriculostomy in patients diagnosed for normal pressure hydrocephalus is not scientifically established. From September 1997 to October 2001 we operated on 79 patients diagnosed for normal pressure hydrocephalus. Diagnosis was established by means of the intrathecal lumbal or ventricular infusion test, the cerebrospinal fluid tap test and MRI-CSF flow studies pre- and post-operatively. In 60 patients (76 %) we implanted a ventriculo-peritoneal shunt (Miethke Dual-Switch valve), and in 15 patients (19 %) we performed the endoscopic assisted third ventriculostomy. With our created NPH recovery rate and use of the clinical grading for normal pressure hydrocephalus created by Kiefer we compared the operative results of both patient groups. Immediately after the operation the results are the same for both treatments. In the follow-up examination after 12 and 27 months patients who underwent a ventriculostomy showed a better outcome, but the underdrainage rate was higher. Concerning the operation related complications the shunt treatment leaded to 10 revisions (17 %) because of four infections (7 %), two shunt insufficiencies (3 %), two overdrainages (3 %), two catheter dislocations (3 %). The ventriculostomy leaded to one case with a pneumatocephalus (7 %) and one ischemic thalamic lesion (7 %). In both operation methods we saw cases of underdrainages, three after valve implantation (5 %) and two after ventriculostomy (13 %). In that patients we performed a change of the implanted valve with a lower pressure level or rather an implantation of a valve system in the two cases who underwent a ventriculostomy. In patients with a pathologically increased resistance to CSF outflow in the lumbal infusion test a shunt implantation with the Miethke Dual-Switch valve is indicated. Patients whose outflow resistance is increased in the ventricular infusion test are suspected for a functional interventricular stenosis and should be treated by means of an endoscopic assisted ventriculostomy.

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Elastance Correlates with Outcome after Endoscopic Third Ventriculostomy in Adults with Hydrocephalus Caused by Primary Aqueductal Stenosis

Cited by 48 publications

References 39 publications

Clinical analysis of aqueductal stenosis in patients with hydrocephalus in a Kenyan setting

Clinical analysis of aqueductal stenosis in patients with hydrocephalus in a Kenyan setting

Perioperative risk factors for short term shunt revisions in adult hydrocephalus patients

Shunt-Operation versus endoskopische Ventrikulostomie beim Normaldruckhydrozephalus: Diagnostik und Outcome

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