Endoscopic Third Ventriculostomy in 250 Adults With Hydrocephalus

Grand, Walter; Leonardo, Jody; Chamczuk, Andrea J.; Korus, Adam J.

doi:10.1227/neu.0000000000000994

Cited by 62 publications

(44 citation statements)

References 73 publications

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“…5,43,44,50,56 In other reports with fewer patients, the success rates range from 0% to 100%. 21,23,26,28,31,33,34,48,53,60,64 Whereas some conclude that re-ETV should be considered in all patients who are referred with recurrent symptoms, others mention that re-ETV remains controversial. We think it is worthwhile to give ETV another chance in selected patients.…”

Section: Discussionmentioning

confidence: 99%

“…44,45 Furthermore, as has been extensively reported in the literature on initial ETV, we found that 64% of failures occurred within the first 6 months after re-ETV. 21,26,35,42,53,55,63 Another reason for choosing ETV over shunt treatment is the apparent difference in concern among the parents of children with hydrocephalus. 40 Although the comfort of parents could be a reason to prefer ETV over shunting, it can also make parents less cautious (i.e., provide a false sense of security), as there is no certainty of a cure for hydrocephalus, and late failure of ETV does occur with potential devastating results.…”

Section: Effect Of Timementioning

confidence: 99%

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

Breimer

Dammers

Woerdeman

et al. 2017

Journal of Neurosurgery: Pediatrics

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OBJECTIVEAfter endoscopic third ventriculostomy (ETV), some patients develop recurrent symptoms of hydrocephalus. The optimal treatment for these patients is not clear: repeat ETV (re-ETV) or CSF shunting. The goals of the study were to assess the effectiveness of re-ETV relative to initial ETV in pediatric patients and validate the ETV success score (ETVSS) for re-ETV.METHODSRetrospective data of 624 ETV and 93 re-ETV procedures were collected from 6 neurosurgical centers in the Netherlands (1998–2015). Multivariable Cox proportional hazards modeling was used to provide an adjusted estimate of the hazard ratio for re-ETV failure relative to ETV failure. The correlation coefficient between ETVSS and the chance of re-ETV success was calculated using Kendall’s tau coefficient. Model discrimination was quantified using the c-statistic. The effects of intraoperative findings and management on re-ETV success were also analyzed.RESULTSThe hazard ratio for re-ETV failure relative to ETV failure was 1.23 (95% CI 0.90–1.69; p = 0.20). At 6 months, the success rates for both ETV and re-ETV were 68%. ETVSS was significantly related to the chances of re-ETV success (τ = 0.37; 95% bias corrected and accelerated CI 0.21–0.52; p < 0.001). The c-statistic was 0.74 (95% CI 0.64–0.85). The presence of prepontine arachnoid membranes and use of an external ventricular drain (EVD) were negatively associated with treatment success, with ORs of 4.0 (95% CI 1.5–10.5) and 9.7 (95% CI 3.4–27.8), respectively.CONCLUSIONSRe-ETV seems to be as safe and effective as initial ETV. ETVSS adequately predicts the chance of successful re-ETV. The presence of prepontine arachnoid membranes and the use of EVD negatively influence the chance of success.

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Section: Discussionmentioning

confidence: 99%

Section: Effect Of Timementioning

confidence: 99%

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

Breimer

Dammers

Woerdeman

et al. 2017

Journal of Neurosurgery: Pediatrics

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“…The largest series published to date included 250 adult patients for whom the mean follow-up was 6 years. 9 The main indication for ETV in the adult population has been to manage diseases that create obstructive hydrocephalus. 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.…”

Section: Discussionmentioning

confidence: 99%

“…9,13,35 Documenting successful treatment of hydrocephalus in a patient with high intracranial pressure is easy to substantiate with this minimal standard, as the outcome of inadequate treatment should be sufficiently obvious because of the underlying life-threatening pathophysiology. It becomes more challenging when patients with chronic hydrocephalus are treated.…”

Section: Outcome Measuresmentioning

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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“…All the patients studied in these research presented intracranial hypertension or other neurological Symptoms, some patients even lost the cognitive competence totally. 8,9) Unfortunately, these repeated insults tend to be neglected. Thus, we aimed to set up an effective approach to treat traumatic brain damage caused by clinical interventions.…”

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confidence: 99%

Osthole Enhances the Therapeutic Efficiency of Stem Cell Transplantation in Neuroendoscopy Caused Traumatic Brain Injury

Tao

Gao

Yan

et al. 2017

Biological & Pharmaceutical Bulletin

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Neuroendoscopy processes can cause severe traumatic brain injury. Existing therapeutic methods, such as neural stem cell transplantation and osthole have not been proven effective. Therefore, there is an emerging need on the development of new techniques for the treatment of brain injuries. In this study we propose to combine the above stem cell based methods and then evaluate the efficiency and accuracy of the new method. Mice were randomly divided into four groups: group 1 (brain injury alone); group 2 (osthole); group 3 (stem cell transplantation); and group 4 (osthole combined with stem cell transplantation). We carried out water maze task to exam spatial memory. Immunocytochemistry was used to test the inflammatory condition of each group, and the differentiation of stem cells. To evaluate the condition of the damaged blood brain barrier restore, we detect the Evans blue (EB) extravasation across the blood brain barrier. The result shows that osthole and stem cell transplantation combined therapeutic method has a potent effect on improving the spatial memory. This combined method was more effective on inhibiting inflammation and preventing neuronal degeneration than the single treated ones. In addition, there was a distinct decline of EB extravasation in the combined treatment groups, which was not observed in single treatment groups. Most importantly, the combined usage of osthole and stem cell transplantation provide a better treatment for the traumatic brain injury caused by neuroendoscopy. The collective evidence indicates osthole combined with neural stem cell transplantation is superior than either method alone for the treatment of traumatic brain injury caused by neuroendoscopy.

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Endoscopic Third Ventriculostomy in 250 Adults With Hydrocephalus

Abstract: Use of ETV in adult hydrocephalus has broad application with a low complication rate and reasonably good efficacy in selected patients.

Cited by 62 publications

References 73 publications

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

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

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

Osthole Enhances the Therapeutic Efficiency of Stem Cell Transplantation in Neuroendoscopy Caused Traumatic Brain Injury

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