Endoscopic third ventriculostomy

Jones, Robert; Stening, W. A.; Brydon, M.

doi:10.1097/00006123-199001000-00012

Cited by 155 publications

(57 citation statements)

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“…(2) High failure rates of ETV in children have been reported by some authors. Jones et al [23] performed ETV in 5 patients aged less than 1 year with a success rate of 60%. Hopf et al [10] reported 4 cases in neonates which all failed.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Transtentorial Ventriculocystostomy and Cystoventriculoperitoneal Shunt in a Neonate with Dandy-Walker Malformation and Associated Aqueductal Obstruction

et al. 2005

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Objective: Shunting of the lateral ventricle and the posterior fossa cyst is the advocated surgical therapy for children with Dandy-Walker malformation (DWM) and associated aqueductal obstruction. The high rate of complications of combined shunting stimulated the authors to search for an alternative surgical solution. Clinical Presentation/Intervention: After transtentorial endoscopic ventriculocystostomy, a cystoventricular catheter, connected to a peritoneal shunt, was placed in a neonate with DWM and associated aqueductal obstruction. Immediately prior to ventriculocystostomy, the presence of a blocked third ventricular outflow was reconfirmed by contrast medium injection. Neuronavigation was required to define the surgical path from the lateral ventricle through the tentorium and the overlying small rim of brain parenchyma into the posterior fossa cyst. The postoperative clinical course was uneventful with radiologically proven reduction of the size of the ventricular system and the cyst. Conclusion: Cystoventriculoperitoneal shunt placement after transtentorial endoscopic ventriculostomy is a surgical alternative in very young children with DWM and associated aqueductal obstruction.

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Section: Discussionmentioning

confidence: 99%

Endoscopic Transtentorial Ventriculocystostomy and Cystoventriculoperitoneal Shunt in a Neonate with Dandy-Walker Malformation and Associated Aqueductal Obstruction

et al. 2005

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“…ETV has been reported to be effective in the treatment of hydrocephalus with success rates ranging between 49 and 100%, depending on the aetiology of hydrocephalus, the criteria used for patient selection, and the follow-up period [2, 3, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15]. Despite these encouraging reports, most authors have suggested that the outcome following ETV is significantly worse in children less than 1 year old as compared with older children [4, 10, 16, 17, 18, 19].…”

Section: Discussionmentioning

confidence: 99%

“…Initially reported to work best in patients with late-onset aqueduct stenosis (AS), endoscopic third ventriculostomy (ETV) is now used in many centres for a wider variety of indications with varying success rates, depending on the aetiology of the hydrocephalus and the patient’s age [1, 2, 3, 4]. Despite the excellent results achieved in adults and older children, the reported outcome of ETV in children less than 1 year old has been disappointing, with success rates ranging between 0 and 23% [2, 5].…”

Section: Introductionmentioning

confidence: 99%

The Impact of Endoscopic Third Ventriculostomy on the Management of Newly Diagnosed Hydrocephalus in Infants

et al. 2001

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Objectives: To evaluate the role of endoscopic third ventriculostomy (ETV) as a primary treatment for hydrocephalus in children less than 1 year old and to determine its impact as a whole on the reduction of shunts necessary in a new population of hydrocephalic infants. Methods: Data were collected prospectively on 47 infants with newly diagnosed hydrocephalus of all aetiologies who were referred between 1st April 1998 and 30th September 2000. Twenty-one patients (median age 6 weeks, range 34 weeks of gestation to 10 months) underwent ETV, while the remaining 26 patients had insertion of a ventriculoperitoneal shunt. Anatomical criteria and demonstration of third ventricle outflow obstruction on preoperative magnetic resonance imaging were used to select patients for ETV. Results: There was no mortality or major morbidity following ETV. The median follow-up period was 18 (range 8–36) months. During the follow-up period, the ETV remained patent in 7 (33%) of the 21 patients. Of the 14 patients with failed ETV, 11 had insertion of a ventriculoperitoneal shunt, while 3 have undergone successful redo ETV. Therefore, in total 10 patients (48%) of the ETV group remain shunt independent. The best results were obtained in patients with congenital aqueduct stenosis with 71% (5 of 7 patients) success rate, while patients with posthaemorrhagic hydrocephalus did particularly badly with only 1 of 10 patients having a successful ETV. Overall, 10 of 47 (21%) infants with newly diagnosed hydrocephalus have avoided a shunt. Conclusions: Our results suggest that the selective use of ETV as the primary treatment in infants with hydrocephalus is safe and can lead to a reduction in the shunted population of all newly diagnosed hydrocephalic infants by up to 21%. Success of ETV is aetiology, not age dependent.

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“…If an increase in valve pressure causes neurological symptoms for patients with a history of overdrainage, adding a TV should be considered in those with obstructive hydrocephalus as an adjunct to facilitate increasing the pressure. Other advantages of maintaining an internal CSF pathway include improvement in brain compliance [12]and maintaining absorption ability, which may help reduce the symptoms of a malfunctioning shunt system [13]. …”

Section: Discussionmentioning

confidence: 99%

Critical Shunt-Induced Subdural Hematoma Treated with Combined Pressure-Programmable Valve Implantation and Endoscopic Third Ventriculostomy

Fukuhara

Vorster

Luciano³

2000

Pediatr Neurosurg

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The authors present 2 patients with VP shunt-induced subdural hematomas (SDH) treated with pressure-programmable valve implantation and endoscopic third ventriculostomies (TV). The first patient is an 11-year-old girl who developed a shunt-induced SDH. Revision of the shunt valve with a higher-pressure valve resulted in a prolonged deterioration of her consciousness. External ventricular drainage at low pressure led to clinical improvement. A pressure-programmable valve set at 50 mm H₂O was implanted, and the pressure gradually increased. At a pressure of 120 mm H₂O symptoms recurred, even though the subdural collection was beginning to decrease in size. An endoscopic TV was performed, and the valve pressure was then increased to 200 mm H₂O without any neurological symptoms. The second patient, a 7-year-old boy with shunt-induced SDH, had recurrent SDH, even after shunt revision with placement of a higher-pressure valve, which resulted in prolonged lethargy. A pressure-programmable valve was implanted with concurrent endoscopic TV. Gradual valve pressure increases up to 200 mm H₂O could be performed without recurrent symptoms. Eventually, the shunt system was ligated to resolve residual positional headache, and the TV has been patent for more than 3 years. In both patients, the pressure-programmable valve was useful, since the optimal CSF drainage pressure changed during the period of recovery from symptomatic subdural collections. Concurrent TV appeared to enable increasing the valve pressure gradually without any neurological symptoms. The advantages of this combined approach are discussed.

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Endoscopic third ventriculostomy

Cited by 155 publications

References 0 publications

Endoscopic Transtentorial Ventriculocystostomy and Cystoventriculoperitoneal Shunt in a Neonate with Dandy-Walker Malformation and Associated Aqueductal Obstruction

Endoscopic Transtentorial Ventriculocystostomy and Cystoventriculoperitoneal Shunt in a Neonate with Dandy-Walker Malformation and Associated Aqueductal Obstruction

The Impact of Endoscopic Third Ventriculostomy on the Management of Newly Diagnosed Hydrocephalus in Infants

Critical Shunt-Induced Subdural Hematoma Treated with Combined Pressure-Programmable Valve Implantation and Endoscopic Third Ventriculostomy

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