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

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

doi:10.1002/14651858.cd010033

Cited by 4 publications

(4 citation statements)

References 52 publications

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“…While surgeons have attempted ETV for elderly patients with iNPH, 14 the published results have not convincingly demonstrated efficacy. 24,29 The clinical triad of findings of iNPH (dementia, gait disturbance, and incontinence) are well known, but the pathophysiology is not understood. There is speculation that symptoms are related to stretching of the subcortical motor and dopaminergic pathways and the frontostriatal pathways.…”

Section: Discussionmentioning

confidence: 99%

Failure of ETV in patients with the highest ETV success scores

Gianaris

Nazar

Middlebrook

et al. 2017

Journal of Neurosurgery: Pediatrics

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OBJECTIVEEndoscopic third ventriculostomy (ETV) is a surgical alternative to placing a CSF shunt in certain patients with hydrocephalus. The ETV Success Score (ETVSS) is a reliable, simple method to estimate the success of the procedure by 6 months of postoperative follow-up. The highest score is 90, estimating a 90% chance of the ETV effectively treating hydrocephalus without requiring a shunt. Treatment with ETV fails in certain patients, despite their being the theoretically best candidates for the procedure. In this study the authors attempted to identify factors that further predicted success in patients with the highest ETVSSs.METHODSA retrospective review was performed of all patients treated with ETV at 3 institutions. Demographic, radiological, and clinical data were recorded. All patients by definition were older than 1 year, had obstructive hydrocephalus, and did not have a prior shunt. Failure of ETV was defined as the need for a shunt by 1 year. The ETV was considered a success if the patient did not require another surgery (either shunt placement or a repeat endoscopic procedure) by 1 year. A statistical analysis was performed to identify factors associated with success or failure.RESULTSFifty-nine patients met the entry criteria for the study. Eleven patients (18.6%) required further surgery by 1 year. All of these patients received a shunt. The presenting symptom of lethargy statistically correlated with success (p = 0.0126, odds ratio [OR] = 0.072). The preoperative radiological finding of transependymal flow (p = 0.0375, OR 0.158) correlated with success. A postoperative larger maximum width of the third ventricle correlated with failure (p = 0.0265).CONCLUSIONSThe preoperative findings of lethargy and transependymal flow statistically correlated with success. This suggests that the best candidates for ETV are those with a relatively acute elevation of intracranial pressure. Cases without these findings may represent the failures in this highly selected group.

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Section: Discussionmentioning

confidence: 99%

Failure of ETV in patients with the highest ETV success scores

Gianaris

Nazar

Middlebrook

et al. 2017

Journal of Neurosurgery: Pediatrics

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“…Thus, an important part of the iNPH investigation is to identify and treat any treatable comorbidities and discuss their potential influence on surgical outcome with the patient and family. If there is any doubt as to 25,26 As of 2016, no medical treatments are effective in iNPH, and, specifically, no evidence supports the use of acetazolamide, 27 although this medication is occasionally prescribed and has been evaluated in a small pilot study. 28…”

Section: Role Of Comorbiditiesmentioning

confidence: 99%

Diagnosis and Treatment of Idiopathic Normal Pressure Hydrocephalus

Williams¹,

Malm²

2016

CONTINUUM: Lifelong Learning in Neurology

160

207

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“…A 2015 Cochrane review reported that the only randomized controlled trial on endoscopic third ventriculostomy versus shunting to meet its criteria for inclusion was unable to determine the effectiveness of the technique due to the use of a nonstandard comparator arm (VP shunting using nonprogrammable valves). 78 As compared with endoscopic third ventriculostomy, results for VP shunting still appear superior. 64,66 Diffusion tensor imaging-A New Direction?…”

Section: Unifying Theoriesmentioning

confidence: 99%

Imaging normal pressure hydrocephalus: theories, techniques, and challenges

Keong

Peña

Price

et al. 2016

FOC

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The pathophysiology of NPH continues to provoke debate. Although guidelines and best-practice recommendations are well established, there remains a lack of consensus about the role of individual imaging modalities in characterizing specific features of the condition and predicting the success of CSF shunting. Variability of clinical presentation and imperfect responsiveness to shunting are obstacles to the application of novel imaging techniques. Few studies have sought to interpret imaging findings in the context of theories of NPH pathogenesis. In this paper, the authors discuss the major streams of thought for the evolution of NPH and the relevance of key imaging studies contributing to the understanding of the pathophysiology of this complex condition.

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

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

Cited by 4 publications

References 52 publications

Failure of ETV in patients with the highest ETV success scores

Failure of ETV in patients with the highest ETV success scores

Diagnosis and Treatment of Idiopathic Normal Pressure Hydrocephalus

Imaging normal pressure hydrocephalus: theories, techniques, and challenges

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