Endoscopic third ventriculostomy in obstructive hydrocephalus: A case report and analysis of operative technique

Abstract

BACKGROUND The endoscopic third ventriculostomy (ETV) is a neuroendoscopical procedure that represents a more suitable alternative to the extracranial shunting. It consists of fenestrating the floor of the third ventricle and thus establishing a free flow of the cerebrospinal fluid from the ventricles to the site of resorption in the subarachnoid space. It offers a more physiological solution and a chance at a shunt-free life for children with hydrocephalus. The main indication for the procedure is obstructive hydrocephalus, however, it can also be useful in patients with other forms of hydrocephalus. CASE SUMMARY We present a treatment flow of a 9-year-old patient, diagnosed with an obstructive hydrocephalus due to tectal glioma that was successfully treated with an ETV. We review the important factors influencing the success rate such as age, aetiology, shunt history, preoperative planning and visualisation of the basilar artery. CONCLUSION Even though the ETV effectively controls obstructive hydrocephalus in more than 75% of all cases, the overall success rate of the procedure varies and could be approved by the correct preoperative patient selection.

Endoscopic Third Ventriculostomy versus Ventriculoperitoneal Shunt in Patients with Obstructive Hydrocephalus: An Updated Systematic Review and Meta-Analysis

“…20 Recently, endoscopic techniques involving ETV were developed and improved, becoming the first-line procedure in the treatment of noncommunicating hydrocephalus. 18,20 The purpose of VPS or ETV is to reduce ICP to improve neurological function. 18,21 ETV is a minimally invasive neurosurgical procedure involving creating a small hole in the floor of the third ventricle, allowing for the CSF to bypass the point of obstruction and flow freely.…”

“…20 Recently, endoscopic techniques involving ETV were developed and improved, becoming the first-line procedure in the treatment of noncommunicating hydrocephalus. 18 20…”

“…Obstructive hydrocephalus refers to obstruction of CSF in the ventricles most commonly due to occlusion of the cerebral aqueduct, colloid cysts, and tumors. [16][17][18] The obstruction may be proximal (aqueduct or third ventricle) or distal (fourth ventricle and its outflow tracts or foramen magnum). 17 Clinically, the symptoms of hydrocephalus are nonspecific and are not necessarily related to the etiology.…”

“…In children, clinical presentations mainly involve headache, nausea, developmental delay, drowsiness, lethargy, and behavioral changes, while in adults, papilledema also has clinical importance. 18 Despite advances in endoscopic techniques and VPS hardware, CSF diversion in the treatment of hydrocephalus remains one of the greatest challenges in neurosurgery. 19 Shunt techniques were popular in the 1960s, due to the worse morbidity and mortality of endoscopic techniques, with a large number of postoperative complications.…”

“…18,20 The purpose of VPS or ETV is to reduce ICP to improve neurological function. 18,21 ETV is a minimally invasive neurosurgical procedure involving creating a small hole in the floor of the third ventricle, allowing for the CSF to bypass the point of obstruction and flow freely. 18,22 Successful ETV is defined as symptom improvement without the need for new shunts.…”