Endoscopic third ventriculostomy for obstructive hydrocephalus

Hellwig, Dieter; Grotenhuis, J.A.; Tirakotai, Wuttipong; Riegel, Thomas; Schulte, Dirk Michael; Bauer, B. L.; Bertalanffy, Helmut

doi:10.1007/s10143-004-0365-2

Cited by 123 publications

(176 citation statements)

References 251 publications

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“…4 Long-term ETV success rates for this entity of greater than 70% up to around 90% have been reported. 6,9,18 In our study CSF diversion resulted in a significant decrease in ventricular volume and third ventricular width. The inability to demonstrate an effect on ventricular size in patients who underwent shunt treatment was explained by the lack of available preoperative imaging in a large portion of those patients.…”

Section: Discussionsupporting

confidence: 53%

Pediatric tectal plate gliomas: clinical and radiological progression, MR imaging characteristics, and management of hydrocephalus

Griessenauer

Rizk

Miller

et al. 2014

PED

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Object Tectal plate gliomas are generally low-grade astrocytomas with favorable prognosis, and observation of the lesion and management of hydrocephalus remain the mainstay of treatment. Methods A cohort of patients with tectal plate gliomas at 2 academic institutions was retrospectively reviewed. Results Forty-four patients with a mean age of 10.2 years who harbored tectal plate gliomas were included in the study. The mean clinical and radiological follow-up was 7.6 ± 3.3 years (median 7.9 years, range 1.5–14.7 years) and 6.5 ± 3.1 years (median 6.5 years, range 1.1–14.7 years), respectively. The most frequent intervention was CSF diversion (81.8% of patients) followed by biopsy (11.4%), radiotherapy (4.5%), chemotherapy (4.5%), and resection (2.3%). On MR imaging tectal plate gliomas most commonly showed T1-weighted isointensity (71.4%), T2-weighted hyperintensity (88.1%), and rarely enhanced (19%). The initial mean volume was 1.6 ± 2.2 cm3 and it increased to 2.0 ± 4.4 cm3 (p = 0.628) at the last follow-up. Frontal and occipital horn ratio (FOHR) and third ventricular width statistically decreased over time (p < 0.001 and p < 0.05, respectively). Conclusions The authors' results support existing evidence that tectal plate gliomas frequently follow a benign clinical and radiographic course and rarely require any intervention beyond management of associated hydrocephalus.

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Section: Discussionsupporting

confidence: 53%

Pediatric tectal plate gliomas: clinical and radiological progression, MR imaging characteristics, and management of hydrocephalus

Griessenauer

Rizk

Miller

et al. 2014

PED

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“…It also offers the possibility of using ETV for treatment of associated hydrocephalus. 9,11 Ventricular tumors represent a heterogeneous group in terms of histology and therapy and often present with common clinical history and radiological aspects. These lesions can be benign or malignant and may simulate malformative or infectious diseases.…”

Section: Discussionmentioning

confidence: 99%

Neuroendoscopic biopsy of ventricular tumors: a multicentric experience

Fiorindi

Benvenuti

et al. 2011

FOC

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Object Although neuroendoscopic biopsy is routinely performed, the safety and validity of this procedure has been studied only in small numbers of patients in single-center reports. The Section of Neuroendoscopy of the Italian Neurosurgical Society invited some of its members to review their own experience, gathering a sufficient number of cases for a wide analysis. Methods Retrospective data were collected by 7 centers routinely performing neuroendoscopic biopsies over a period of 10 years. Sixty patients with newly diagnosed intraventricular and paraventricular tumors were included. No patient harboring a colloid cyst was included. Data regarding clinical presentation, neuroimaging findings, operative techniques, pathological diagnosis, postoperative complications, and subsequent therapy were analyzed. Results In all patients, a neuroendoscopic tumor biopsy was performed. In 38 patients (64%), obstructive hydrocephalus was present. In addition to the tumor biopsy, 32 patients (53%) underwent endoscopic third ventriculostomy (ETV), and 7 (12%) underwent septum pellucidotomy. Only 2 patients required a ventriculoperitoneal shunt shortly after the endoscopy procedure because ETV was not feasible. The major complication due to the endoscopy procedure was ventricular hemorrhage noted on the postoperative images in 8 cases (13%). Only 2 patients were symptomatic and required medical therapy. Infection occurred in only 1 case, and the other complications were all reversible. In no case did clinically significant sequelae affect the patient's outcome. Tumor types ranged across the spectrum and included glioma (low- and high-grade [27%]), pure germinoma (15%), pineal parenchymal tumor (12%), primary neuroectodermal tumor (4%), lymphoma (9%), metastasis (4%), craniopharyngioma (6%), and other tumor types (13%). In 10% of patients, the pathological findings were inconclusive. According to diagnosis, specific therapy was performed in 35% of patients: 17% underwent microsurgical removal, and 18% underwent chemotherapy or radiotherapy. Conclusions This is one of the largest series confirming the safety and validity of the neuroendoscopic biopsy procedure. Complications were relatively low (about 13%), and they were all reversible. Neuroendoscopic biopsy provided meaningful pathological data in 90% of patients, making subsequent tumor therapy feasible. Cerebrospinal fluid pathways can be restored by ETV or septum pellucidotomy (65%) to control intracranial hypertension. In light of the results obtained, a neuroendoscopic biopsy should be considered a possible alternative to the stereotactic biopsy in the diagnosis and treatment of ventricular or paraventricular tumors. Furthermore, it could be the only surgical procedure necessary for the treatment of selected tumors.

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“…Endoscopic third ventriculostomy is established as an advantageous treatment alternative compared with ventriculoperitoneal shunting in selected patients with noncommunicating hydrocephalus. 11,12,15 The patient with noncommunicating hydrocephalus due to a posterior third ventricular or pineal region tumor is an ideal candidate for ETV. Adding only several additional minutes to the surgical procedure, ETV is easily integrated at the time of tissue biopsy.…”

Section: Advances In Neurosurgical Managementmentioning

confidence: 99%

Surgical management of primary central nervous system germ cell tumors

Souweidane

Krieger

Weiner

et al. 2010

PED

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The successful treatment of children with a primary CNS germ cell tumor can be greatly influenced by the neurosurgeon involved in the diagnostic and therapeutic care of these children. Variability in surgical philosophies no doubt exists due to the relatively infrequent incidence of these tumors, a lack of consensus regarding diagnostic and therapeutic approaches, and the advent of recent surgical innovations. Many of these issues were discussed at the Second International Symposium on Central Nervous System Germ Cell Tumors through presented abstracts and invited presentations. The neurosurgical aspects of these proceedings are summarized here in an effort to present the agreed-upon and debated issues that may confront the pediatric neurosurgeon.

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Endoscopic third ventriculostomy for obstructive hydrocephalus

Cited by 123 publications

References 251 publications

Pediatric tectal plate gliomas: clinical and radiological progression, MR imaging characteristics, and management of hydrocephalus

Pediatric tectal plate gliomas: clinical and radiological progression, MR imaging characteristics, and management of hydrocephalus

Neuroendoscopic biopsy of ventricular tumors: a multicentric experience

Surgical management of primary central nervous system germ cell tumors

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