Endoscopic third ventriculostomy - effectiveness of the procedure for obstructive hydrocephalus with different etiology in adults.

Abstract

IntroductionAfter a time of domination of shunt placement, endoscopic third ventriculostomy (ETV) has been increasingly applied in treatment of obstructive hydrocephalus.AimTo assess the effectiveness of ETV in treatment of adults with three-ventricle hydrocephalus of different etiology.Material and methodsNinety-six patients with obstructive hydrocephalus were studied: 24 with primary aqueductal stenosis, 61 with brain tumor, and 2 with basilar tip aneurysm. In 9 patients the etiology of hydrocephalus remained undetermined. The assessment of treatment results was based on clinical and radiological criteria.ResultsClinical improvement was observed in 74 (77.1%) patients, and radiological improvement in 52 (54.2%). One patient died. Follow-up of 24 patients with primary aqueductal stenosis has shown that in 20 (83.3%) of them clinical improvement has been stable, and in 14 (58.3%) radiological improvement has been observed. Two patients required shunt placement due to hydrocephalus recurrence 12–24 months after the ETV procedure. Among 9 patients with undefined hydrocephalus, 3 required shunt placement within 6 months after ETV (2 shunted previously). Endoscopic third ventriculostomy treatment in a patient with hydrocephalus caused by basilar tip aneurysm succeeded. The assessment of ETV effectiveness in oncological patients has been indirect in view of the underlying disease.ConclusionsThe best results of ETV treatment have been demonstrated for patients with primary aqueductal stenosis. Ventricle size cannot determine the effectiveness of treatment as an individual requirement. Endoscopic third ventriculostomy is effective in previously shunted patients although the prediction of outcome should be cautious. Endoscopic third ventriculostomy enables preparation for further therapy and is palliative treatment in oncological patients with secondary hydrocephalus.

Non-Tumor Obstructive Hydrocephalus Treated with Endoscopic Third Ventriculostomy in Cameroon

“…The best success rates are reported for primary aqueductal stenosis and range from 50% -100%. The success rate of 95% (19/20 patients) from this series is similar to those from other authors [1] [25] and may rely on the fact that in 18 (90%) patients, hydrocephalus was caused by primary aqueduct stenosis even though it was associated with myelomeningocele and shunt failure in one case each. In Zanzibar and Kenya, Piquer et al [4] achieved a 73% success rate in patients with aqueduct stenosis and 1 year old or above.…”

“…This was the case for other series reported from Sub-Saharan Africa [1] [3]. From the series of Warf BC [5] [6] [8] in Uganda, operative mortality of ETV ranged between 1.1 and 1.8%.Worldwide reported perioperative mortality is 0% -1.5% [25].…”

“…Overall, morbidity and mortality related to ETV are low. Reported morbidity rates are 5% -15% and permanent morbidity is 0% -2.1% [25]. In our series we had 2 (10%) transient post-operative complications in the form of CSF leak.…”

“…The overall success rates of ETV reported from medical literature range from 17% to 100% [1] [3] [13]- [18] [21]- [25]. Success rate is related to type and etiology of hydrocephalus, patient's age, primary versus repeated ETV and operative technique.…”

Neuroendoscopic Intervention for the Deep Midline Brain Tumors with Secondary Occlusive Hydrocephalus

“…Marked interventions often contribute to the development of severe complications, such as infection and occlusion of shunts, particularly in decompensated patients [1,3]. An alternative to these interventions for SON elimination in BT patients is endoscopic third ventriculocisternostomy (ETV), which contributes to the creation of new the CSF pathway, that provide drainage of excess CSF to subarachnoidal space via cisterns [5][6][7][8]. The bypass surgery is mainly performed by leading neurosurgeons, as is ETV with simultaneous tumor removal.…”