Endoscopic third ventriculostomy in the treatment of hydrocephalus in posterior fossa tumors in children

Ruggiero, Claudio; Cinalli, Giuseppe; Spennato, Pietro; Aliberti, Ferdinando; Cianciulli, Emilio; Trischitta, Vincenzo; Maggi, G

doi:10.1007/s00381-004-0938-y

Cited by 122 publications

(75 citation statements)

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“…ETV as an alternative procedure to either VP shunting or EVD has been found very effective for the emergency control of severe hydrocephalus caused by posterior fossa tumors since it can quickly eliminate symptoms (19) and has more recently been recommended by some authors as the first choice treatment option owing to shorter duration of surgery, lower morbidity, lower failure rate as well as the obviously significant advantage of avoiding shunt dependence (8). Success rates ranging from 50% to 95% have been reported in the literature (2, 7,9,11,19,21,22). In our series, a success rate of 88.2% was achieved.…”

Section: Resultsmentioning

confidence: 99%

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Preoperative endoscopic third ventriculostomy in children with posterior fossa tumors: an institution experience

Azab¹,

Alsheikh²,

Yahia³

2012

Turkish Neurosurgery

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AIm:To assess the effectiveness and safety of pre-resection endoscopic third ventriculostomy (ETV) in permanently relieving hydrocephalus in children with posterior fossa tumors. mAterIAl and methOds: 17 pediatric patients with posterior fossa tumors and associated triventricular obstructive hydrocephalus underwent ETV before definitive tumor resection, and ETV was repeated after tumor resection if hydrocephalus with increased intracranial pressure persisted or recurred. The medical records, operative notes and imaging studies were retrospectively reviewed.results: 18 ETV procedures were performed in 17 patients, consisting of 11 males and 6 females, age range (1.5 to 13 years; mean 6±3.86). Follow-up periods ranged from 6 to 23 months (mean follow-up 13.9±5.4 months). ETV was successful in relieving hydrocephalus during the follow-up period in 15 out of 17 patients (88.2%). Prior to surgical excision of the posterior fossa tumors, no failures of ETV were detected and all of the 17 patients showed marked clinical improvement and radiological disappearance of signs of active hydrocephalus.COnClusIOn: Preoperative ETV is a highly effective long-term CSF diversion procedure for treatment of hydrocephalus associated with posterior fossa tumors in children. In experienced hands, ETV has a very low complication rate.KeywOrds: Hydrocephalus, Endoscopic third ventriculostomy, Posterior fossa tumor ÖZ AmAÇ: Posterior fossa tümörlü çocuklarda hidrosefaliyi kalıcı olarak tedavi etmek üzere rezeksiyon öncesi endoskopik üçüncü ventrikülosto-minin (ETV) etkinlik ve güvenliğini değerlendirme. yÖntem ve GereÇler: Posterior fossa tümörlü ve ilişkili triventriküler obstrüktif hidrosefalili 17 pediatrik hastada kesin tümör rezeksiyonu öncesinde ETV yapıldı ve ETV işlemi eğer artmış intrakraniyal basınçlı hidrosefali devam ediyorsa veya tekrarlarsa tümör rezeksiyonu sonrasında tekrarlandı. Tıbbi kayıtlar, ameliyat notları ve görüntüleme çalışmaları retrospektif olarak gözden geçirildi.BulGulAr: Yaş aralığı 1,5-13 yıl (ortalama 6±3,86) olan ve 11 erkek ve 6 kadından oluşan 17 hastada 18 ETV işlemi yapıldı. Takip dönemleri 6 ile 23 ay arasındaydı (ortalama takip 13,9±5,4 ay). ETV, takip döneminde 17 hastanın 15'inde (%88,2) hidrosefaliyi tedavi etmekte başarılıydı. Posterior fossa tümörlerinin cerrahi insizyonu öncesinde herhangi bir ETV başarısızlığı saptanmadı ve 17 hastanın tümünde belirgin klinik iyileşme ve aktif hidrosefali bulgularının radyolojik olarak kaybolması görüldü. sOnuÇ: Preoperatif ETV çocuklarda posterior fossa tümörleriyle ilişkili hidrosefalinin tedavisinde çok etkin, uzun dönemli bir BOS dİversiyonu işlemidir. Deneyimli ellerde, ETV'nin komplikasyon oranı çok düşüktür AnAhtAr sÖZCÜKler: Hidrosefali, Endoskopik üçüncü ventrikülostomi, Posterior fossa tümörü

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Section: Resultsmentioning

confidence: 99%

“…As an alternative procedure to either ventriculoperitoneal (VP) shunting or external ventricular drainage (EVD), ETV has been found very effective for the emergency control of severe hydrocephalus in these patients since it can quickly eliminate symptoms (19).…”

Section: Introductionmentioning

confidence: 99%

Preoperative endoscopic third ventriculostomy in children with posterior fossa tumors: an institution experience

Azab¹,

Alsheikh²,

Yahia³

2012

Turkish Neurosurgery

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“…Sainte-Rose et al 33 reported in their series of 196 pediatric patients that only 3 (6.4%) of 47 patients with preoperative hydrocephalus treated by ETV needed postoperative shunting, compared with 16 (19.5%) of 82 patients without preoperative ETV. Other series have reported similar high ETV success rates, 2,32,33 although these series involved pediatric patients with posterior fossa tumors. In our study, 8 (6.5%) of 124 cases underwent ETV prior to craniotomy for relief of preoperative hydrocephalus, none of whom went on to require an early VP shunt after craniotomy (Fig.…”

Section: Preoperative Hydrocephalus and Its Treatmentmentioning

confidence: 81%

Cerebrospinal fluid disturbances after 381 consecutive craniotomies for intracranial tumors in pediatric patients

Hosainey

Lassen

Helseth

et al. 2014

PED

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Object The aim of this study was to investigate the incidence of CSF disturbances before and after intracranial surgery for pediatric brain tumors in a large, contemporary, single-institution consecutive series. Methods All pediatric patients (those < 18 years old), from a well-defined population of 3.0 million inhabitants, who underwent craniotomies for intracranial tumors at Oslo University Hospital in Rikshospitalet between 2000 and 2010 were included. The patients were identified from the authors' prospectively collected database. A thorough review of all medical charts was performed to validate all the database data. Results Included in the study were 381 consecutive craniotomies, performed on 302 patients (50.1% male, 49.9% female). The mean age of the patients in the study was 8.63 years (range 0–17.98 years). The follow-up rate was 100%. Primary craniotomies were performed in 282 cases (74%), while 99 cases (26%) were secondary craniotomies. Tumors were located supratentorially in 249 cases (65.3%), in the posterior fossa in 105 (27.6%), and in the brainstem/diencephalon in 27 (7.1%). The surgical approach was supratentorial in 260 cases (68.2%) and infratentorial in 121 (31.8%). Preoperative hydrocephalus was found in 124 cases (32.5%), and 71 (86.6%) of 82 achieved complete cure with tumor resection only. New-onset postoperative hydrocephalus was observed in 9 (3.5%) of 257 cases. The rate of postoperative CSF leaks was 6.3%. Conclusions Preoperative hydrocephalus was found in 32.5% of pediatric patients with brain tumors treated using craniotomies. Tumor resection alone cured preoperative hydrocephalus in 86.6% of cases and the incidence of new-onset hydrocephalus after craniotomy was only 3.5%.

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“…23,24 However, in the new millennium, precraniotomy shunting has been practically abandoned in countries with abun dant resources because of the associated shunt complica tions. 4,10,35,36,39 Alternatively, "routine" ETV before cra niotomy has been recommended for the management of hydrocephalus secondary to posterior fossa tumors. 6,35,36 This technique reduced the necessity of implanting a per manent CSF shunt device from approximately 35% 25,39 to only 6% 36 of cases, with subsequent avoidance of many shuntrelated complications.…”

Section: Discussionmentioning

confidence: 99%

Infratentorial complications following preresection CSF diversion in children with posterior fossa tumors

El-Gaidi¹,

El-Nasr²,

Eissa³

2015

PED

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OBJECT This report presents the incidence, causes, and morbidity and mortality of infratentorial complications following CSF diversion before resection in children with posterior fossa tumors. METHODS The medical records of 437 children admitted to Abo El-Reesh Pediatric University Hospital with a diagnosis of posterior fossa tumor between 2005 and 2012 were retrospectively reviewed. Seven children developed neurological deterioration following CSF diversion due to infratentorial complications. Computed tomography scans revealed intratumoral hemorrhage (ITH) in 5 cases, while upward transtentorial herniation (UTH), as evidenced by obliteration of the quadrigeminal and ambient cisterns, was diagnosed in 2 cases. RESULTS Hydrocephalus was noted in 381 patients, and 301 patients underwent CSF diversion before resection. A ventriculoperitoneal (VP) shunt was used in 214 patients, and 6 children (2.8% of shunted cases) deteriorated neurologically (4 due to ITH and 2 due to UTH). Endoscopic third ventriculostomy (ETV) was performed in 87 patients, 1 of whom developed ITH (1.1% of the patients undergoing ETV). Six patients deteriorated within 8 hours (85.7%), whereas 1 patient, the only survivor, deteriorated after 24 hours. The incidence of infratentorial complications between VP shunts and ETVs was not found to be significantly different (p = 0.659). There was a higher risk of such complications in large posterior fossa tumors (diameter ≥ 4 cm) extending close to the tentorial incisura, especially in patients with severe hydrocephalus and significant peritumoral edema. CONCLUSIONS Infratentorial complications (ITH and UTH) in children with posterior fossa tumors are not uncommon (2.3%) after preresection CSF diversion (VP shunt or ETV) and are associated with a very poor prognosis in most cases, even with surgical intervention.

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Endoscopic third ventriculostomy in the treatment of hydrocephalus in posterior fossa tumors in children

Cited by 122 publications

References 20 publications

Preoperative endoscopic third ventriculostomy in children with posterior fossa tumors: an institution experience

Preoperative endoscopic third ventriculostomy in children with posterior fossa tumors: an institution experience

Cerebrospinal fluid disturbances after 381 consecutive craniotomies for intracranial tumors in pediatric patients

Infratentorial complications following preresection CSF diversion in children with posterior fossa tumors

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