Endoscopic Third Ventriculostomy in Patients with Malfunctioning CSF-Shunt

Melikian, A G; Korshunov, A E

doi:10.1016/j.wneu.2010.08.005

Cited by 18 publications

(7 citation statements)

References 20 publications

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“…This adds data to the claim that one can achieve good outcomes in the setting of shunt malfunction. 3,4,6,23,25 Furthermore, 7 of 12 patients with previously shunted myelomeningocele (58.3%) were reoperation free at 6 months following ETV. Teo and Jones have reported an even better 80% success rate in their group of previously shunt-treated patients with spina bifida when they were > 6 months old at the time of endoscopy.…”

Section: Discussionmentioning

confidence: 99%

Predicting success of endoscopic third ventriculostomy: validation of the ETV Success Score in a mixed population of adult and pediatric patients

Labidi

Lavoie

Lapointe

et al. 2015

JNS

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The ETVSS did not show adequate discrimination but demonstrated excellent calibration in this population of patients 2 years and older. According to decision-curve analyses, the ETVSS is marginally useful in clinical scenarios in which 60% or 70% success rates are the thresholds for preferring ETV to CSF shunt. Previous history of CSF shunt and age were not associated with worse outcomes, whereas posthemorrhagic and postinfectious causes of the hydrocephalus were significantly associated with reduced success rates following ETV.

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Section: Discussionmentioning

confidence: 99%

Predicting success of endoscopic third ventriculostomy: validation of the ETV Success Score in a mixed population of adult and pediatric patients

Labidi

Lavoie

Lapointe

et al. 2015

JNS

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“…Formerly shunted patients have less favorable results, somewhat greater risk of serious complications; therefore, more experience is essential when offering them an ETV. [38] Carefully selected patients with obstructive hydrocephalus could benefit from ETV after shunt malfunction, and about 70% become shunt free. On the other hand, looking to the poor results, Woodworth et al [39] suggested that the ETV combined with concurrent CSF shunting may be an important strategy to prevent catastrophic treatment failure in obstructive hydrocephalus patients, with a history of multiple shunt revisions and complications.…”

Section: Myelomeningocele With Hydrocephalusmentioning

confidence: 99%

Endoscopic third ventriculostomy

Yadav

Parihar

Pande

et al. 2012

Journal of Neurosciences in Rural Practice

101

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Endoscopic third ventriculostomy (ETV) is considered as a treatment of choice for obstructive hydrocephalus. It is indicated in hydrocephalus secondary to congenital aqueductal stenosis, posterior third ventricle tumor, cerebellar infarct, Dandy-Walker malformation, vein of Galen aneurism, syringomyelia with or without Chiari malformation type I, intraventricular hematoma, post infective, normal pressure hydrocephalus, myelomeningocele, multiloculated hydrocephalus, encephalocele, posterior fossa tumor and craniosynostosis. It is also indicated in block shunt or slit ventricle syndrome. Proper Pre-operative imaging for detailed assessment of the posterior communicating arteries distance from mid line, presence or absence of Liliequist membrane or other membranes, located in the prepontine cistern is useful. Measurement of lumbar elastance and resistance can predict patency of cranial subarachnoid space and complex hydrocephalus, which decides an ultimate outcome. Water jet dissection is an effective technique of ETV in thick floor. Ultrasonic contact probe can be useful in selected patients. Intra-operative ventriculo-stomography could help in confirming the adequacy of endoscopic procedure, thereby facilitating the need for shunt. Intraoperative observations of the patent aqueduct and prepontine cistern scarring are predictors of the risk of ETV failure. Such patients may be considered for shunt surgery. Magnetic resonance ventriculography and cine phase contrast magnetic resonance imaging are effective in assessing subarachnoid space and stoma patency after ETV. Proper case selection, post-operative care including monitoring of ICP and need for external ventricular drain, repeated lumbar puncture and CSF drainage, Ommaya reservoir in selected patients could help to increase success rate and reduce complications. Most of the complications develop in an early post-operative, but fatal complications can develop late which indicate an importance of long term follow up.

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“…Past history of shunting and age was not found to be associated with poor outcome unlike the post-hemorrhage and post-infectious causes of hydrocephalus which correlated with reduced success rates post ETV. Melikian and Korshunov37) observed that ETV done in cases of shunt malfunction in obstructive hydrocephalus gave a 70% chance of long term shunt free status.…”

Section: Etv Success Score As a Predictive Toolmentioning

confidence: 99%