Endoscopic Third Ventriculostomy, Indications and Challenges

Abstract

Endoscopic third ventriculostomy (ETV) allows the cerebrospinal fluid (CSF) to flow directly from the third ventricle through the fashioned ventriculostoma to the interpeduncular cistern, by passing the site of obstruction. In spite of the wide variety of indications where ETV is implemented, its success rate is still debatable especially in certain age groups, where it is most successful in adult patients with obstructive hydrocephalus and it has an identifiable failure rate in children less than 6 months of age. Several factors would affect the success rate of ETV, which are related to the patient's age, pathology, and intraoperative findings. This chapter covers most of the current debates considering ETV.

Endoscopic third ventriculostomy for management of hydrocephalus associated with Chiari malformation type II in children

“…Most authors would agree that coexisting hydrocephalus with CM II should be managed with CSF diversion first, either by shunting or ETV, before consideration is given to posterior fossa decompression [5,6]. With the advent of neuro-endoscopic procedures, more and more cases of hydrocephalus are being treated by ETV to avoid shunt dependence [7,8]. Several authors have reported the success of ETV in the management of hydrocephalus in patients with CM II with good clinical and radiological outcomes [9][10][11][12].…”

Endoscopic Endonasal Transsphenoidal Approach for Third Ventriculostomy in the Management of Obstructive Hydrocephalus

“…Management of hydrocephalus is still a challenging issue because all currently available therapeutic modalities have recognizable failure rates 1,2 . Endoscopic third ventriculostomy (ETV) is a well-established method in the management of hydrocephalus.…”

“…An ETV Success Score (ETVSS) was initially designed by Kulkarni et al to predict a 6-month outcome with age, etiology, and previous shunt 3 . Accordingly, ETV has the highest success rate for adult patients with obstructive hydrocephalus 1,4–6 . ETV is performed through a frontal burr hole to allow internal inspection and manipulation of the ventricular system.…”

“…In addition to the ETVSS, visualization of a naked basilar artery (BA), mobility of stoma, and Liliequist perforation were predictive of ETV success 8,9 . However, complications occurred in 5–15% patients, which include bleeding, neural structures injury, mistrajectory, infection, subdural effusion, and CSF leak 1,4,5,10,11 . In addition, late failure or reclosure harbors potential risk of deterioration after ETV 1 …”

“…However, complications occurred in 5–15% patients, which include bleeding, neural structures injury, mistrajectory, infection, subdural effusion, and CSF leak 1,4,5,10,11 . In addition, late failure or reclosure harbors potential risk of deterioration after ETV 1 …”