Endoscopic third ventriculostomy: can we predict success during surgery?

Abstract

Endoscopic third ventriculostomy (ETV) is widely used as an alternative technique for hydrocephalus treatment. ETV success or failure may be influenced by numerous factors. In this study, we have analyzed preoperative and intraoperative risk factors and suggest an intraoperative scale to predict etV failure. Fifty-one patients (27 adults and 24 children) underwent an etV at Carlos Haya University Hospital, Malaga. Intraoperative video records were assessed and the following intraoperative findings were recorded: (1) abnormal ventricular anatomy, (2) intraoperative incident, (3) Liliequist membrane opening in a second endoscopic maneuver, (4) thickened or scarred membranes in the subarachnoid space, (5) absence or "weakness" of pulsation of third ventricle floor at etV completion, and (6) floppy premammillary membrane that needs edge coagulation. An intraoperative scale ranging from 0 to 6 points was performed. A significant relation was found between a higher result on the prognosis scale and etV failure (p < 0.0001). An absence or weakness of pulsation of the third ventricle floor at etV completion was significantly related to etV failure (p < 0.0001). The presence of thickened or scarred membranes in the subarachnoid space was significantly related to etV failure (p < 0.04) as well as the Liliequist membrane opening in a second endoscopic maneuver (p < 0.008). Intraoperative factors should be taken into account for prediction of etV success. More studies with larger case series are needed to determine the influence of all intraoperative factors over etV success.

Stented endoscopic third ventriculostomy—indications and results

“…Interestingly, upon reoperation, we observed a wide-open third ventricular floor, but a formation of new arachnoid membranes creating a crate-like formation around the position of the former tip of the stent. This is in accordance with the previous observations that the status of the prepontine cistern regarding membranous obstruction seems to be relevant for success of an ETV [28,36] and that indeed new membrane formation has been previously demonstrated to be responsible for ETV failure [35]. Therefore, simply securing the achieved opening by a stent seems to be not sufficient in the infant age group.…”

Predicting success of endoscopic third ventriculostomy: validation of the ETV Success Score in a mixed population of adult and pediatric patients

“…Previous studies have submitted different models of predicting ETV success, including variables not taken into account by the ETVSS. Some of these models relied on preoperative clinical factors or neuroradiological parameters, 2,19 whereas others were built on operative findings 13,27 or early postoperative variables. 28 In our series, none of the studied surgical variables (third ventricular floor opacity, significant bleeding during endoscopy, concurrent biopsy, surgeon experience, and Liliequist membrane opening) were predictive of ETV success, except for the decision by the neurosurgeon to leave an EVD at the end of the case.…”

Endoscopic third ventriculostomy and repeat endoscopic third ventriculostomy in pediatric patients: the Dutch experience

“…2,12,19,50,52,67,69 A thicker third ventricle floor has been negatively associated with ETV success, 59 but unfortunately we could not retrospectively analyze this aspect. The presence of cisternal scarring has been negatively associated with success of the first ETV.…”