Endoscopic third ventriculostomy (ETV) for idiopathic normal pressure hydrocephalus (iNPH)

Tudor, Katarina Ivana; Tudor, Mario; McCleery, Jenny; Car, Josip

doi:10.1002/14651858.cd010033.pub2

Cited by 31 publications

(24 citation statements)

References 75 publications

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“…While there have been attempts to expand the scope of potential indications for ETV to include nonobstructive hydrocephalic diseases, such as iNPH, [5][6][7] conclusive data are still lacking. 32 The vast majority of reported experience with ETV in the adult population relates to patients presenting with a new diagnosis of an obstructive pattern of hydrocephalus. However, there is also an increasing experience with using ETV to treat patients presenting with shunt failure when there is an underlying diagnosis of obstructive hydrocephalus.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic third ventriculostomy for treatment of adult hydrocephalus: long-term follow-up of 163 patients

Isaacs¹,

Bezchlibnyk²,

Yong

et al. 2016

FOC

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OBJECTIVE The efficacy of endoscopic third ventriculostomy (ETV) for the treatment of pediatric hydrocephalus has been extensively reported in the literature. However, ETV-related long-term outcome data are lacking for the adult hydrocephalus population. The objective of the present study was to assess the role of ETV as a primary or secondary treatment for hydrocephalus in adults. METHODS The authors performed a retrospective chart review of all adult patients (age ≥ 18 years) with symptomatic hydrocephalus treated with ETV in Calgary, Canada, over a span of 20 years (1994–2014). Patients were dichotomized into a primary or secondary ETV cohort based on whether ETV was the initial treatment modality for the hydrocephalus or if other CSF diversion procedures had been previously attempted respectively. Primary outcomes were subjective patient-reported clinical improvement within 12 weeks of surgery and the need for any CSF diversion procedures after the initial ETV during the span of the study. Categorical and actuarial data analysis was done to compare the outcomes of the primary versus secondary ETV cohorts. RESULTS A total of 163 adult patients with symptomatic hydrocephalus treated with ETV were identified and followed over an average of 98.6 months (range 0.1–230.4 months). All patients presented with signs of intracranial hypertension or other neurological symptoms. The primary ETV group consisted of 112 patients, and the secondary ETV consisted of 51 patients who presented with failed ventriculoperitoneal (VP) shunts. After the initial ETV procedure, clinical improvement was reported more frequently by patients in the primary cohort (87%) relative to those in the secondary ETV cohort (65%, p = 0.001). Additionally, patients in the primary ETV group required fewer reoperations (p < 0.001), with cumulative ETV survival time favoring this primary ETV cohort over the course of the follow-up period (p < 0.001). Fifteen patients required repeat ETV, with all but one experiencing successful relief of symptoms. Patients in the secondary ETV cohort also had a higher incidence of complications, with one occurring in 8 patients (16%) compared with 2 in the primary ETV group (2%; p = 0.010), although most complications were minor. CONCLUSIONS ETV is an effective long-term treatment for selected adult patients with hydrocephalus. The overall ETV success rate when it was the primary treatment modality for adult hydrocephalus was approximately 87%, and 99% of patients experience symptomatic improvement after 2 ETVs. Patients in whom VP shunt surgery fails prior to an ETV have a 22% relative risk of ETV failure and an almost eightfold complication rate, although mostly minor, when compared with patients who undergo a primary ETV. Most ETV failures occur within the first 7 months of surgery in patients treated with primary ETV, but the time to failure is more prolonged in patients who present with failed previous shunts.

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Section: Discussionmentioning

confidence: 99%

Endoscopic third ventriculostomy for treatment of adult hydrocephalus: long-term follow-up of 163 patients

Isaacs¹,

Bezchlibnyk²,

Yong

et al. 2016

FOC

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“…Concomitantly, development of “smart” shunts with telemetry, incorporated monitors, and auto‐regulated valves has the potential to improve the treatment outcome 121 . To avoid the permanent implantation of shunts, endoscopic third ventriculostomy (ETV), a procedure formerly demonstrated to be effective in obstructive hydrocephalus, is gaining attention as a surgical treatment of iNPH 122 . In some studies, the ETV had similar or even superior efficacy and lower complication rates comparing to the shunting procedures 122 .…”

Section: Current and Prospective Treatment Strategiesmentioning

confidence: 99%

Pathogenesis and pathophysiology of idiopathic normal pressure hydrocephalus

Wang

Zhang

et al. 2020

CNS Neurosci Ther

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First defined in 1965, idiopathic normal pressure hydrocephalus (iNPH)is a surgically reversible neurological disorder in adults. It is characterized by dementia, gait disturbance, and urinary incontinence (known as Hakim's triad). 1,2 INPH is not a rare clinical entity. The prevalence of iNPH has been estimated to be 10 per 100 000 to 22 per 100 000 overall, with 1.30% in those aged ≥65 years and 5.9% in those aged ≥80 years. 3,4 One of the core features of iNPH is that the cerebrospinal fluid (CSF) pressure of an iNPH patient is within normal ranges. 2 Typical brain imaging of iNPH displays ventriculomegaly, periventricular hyperintensities, wide Sylvian fissures, narrowed subarachnoid space, and cortical sulci at the high convexity. 5 In contrast to the secondary normal pressure hydrocephalus with known etiology, the exact cause of iNPH is unknown. 6 Its specific pathogenesis also remains elusive, although several

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“…In controlled trials, ETV has reasonable efficacy in pediatric hydrocephalus particularly for aqueduct stenosis [ 6 , 7 ]. ETV requires more robust evidence for routine use in adult normal pressure hydrocephalus (NPH) [ 8 ]. Lumboperitoneal shunting also shows some promise in NPH [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Nonsurgical therapy for hydrocephalus: a comprehensive and critical review

Bigio

Curzio

2015

Fluids Barriers CNS

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Pharmacological interventions have been tested experimentally and clinically to prevent hydrocephalus and avoid the need for shunting beginning in the 1950s. Clinical trials of varied quality have not demonstrated lasting and convincing protective effects through manipulation of cerebrospinal fluid production, diuresis, blood clot fibrinolysis, or manipulation of fibrosis in the subarachnoid compartment, although there remains some promise in the latter areas. Acetazolamide bolus seems to be useful for predicting shunt response in adults with hydrocephalus. Neuroprotection in the situation of established hydrocephalus has been tested experimentally beginning more recently. Therapies designed to modify blood flow or pulsation, reduce inflammation, reduce oxidative damage, or protect neurons are so far of limited success; more experimental work is needed in these areas. As has been recommended for preclinical studies in stroke and brain trauma, stringent conditions should be met for preclinical studies in hydrocephalus.Electronic supplementary materialThe online version of this article (doi:10.1186/s12987-016-0025-2) contains supplementary material, which is available to authorized users.

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Endoscopic third ventriculostomy (ETV) for idiopathic normal pressure hydrocephalus (iNPH)

Cited by 31 publications

References 75 publications

Endoscopic third ventriculostomy for treatment of adult hydrocephalus: long-term follow-up of 163 patients

Endoscopic third ventriculostomy for treatment of adult hydrocephalus: long-term follow-up of 163 patients

Pathogenesis and pathophysiology of idiopathic normal pressure hydrocephalus

Nonsurgical therapy for hydrocephalus: a comprehensive and critical review

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