Endoscopic Third Ventriculostomy: Outcome Analysis of an Anterior Entry Point

Aref, Mohammed; Martyniuk, Amanda; Nath, Siddharth; Koziarz, Alex; Badhiwala, Jetan H.; Algird, Almunder; Farrokhyar, Forough; Almenawer, Saleh A.; Reddy, Kesava

doi:10.1016/j.wneu.2017.05.052

Cited by 15 publications

(11 citation statements)

References 23 publications

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“…The location of the ventricular thalamic hemorrhage is deep and the surrounding structures are important. It is di cult to remove a hematocele from the thalamus and ventricle, relieve the ventricular infarction, and restore the cerebrospinal uid circulation in a timely fashion [5] . The clinical curative effect is usually poor, and the disability and mortality rates are high.…”

Section: Discussionmentioning

confidence: 99%

“…Eighty-three patients with severe ventricular thalamic hemorrhage treated by neurosurgery in Anqing Hospital A liated to Anhui Medical University from July 2019 to August 2021 were enrolled in the current study, including 41 patients who underwent neuroendoscopic surgery and 42 patients who underwent simple extraventricular drainage. The inclusion criteria were as follows: (1) met the diagnostic criteria for ventricular thalamic hemorrhage formulated by the American Stroke Association in 2015; (2) < 75 years of age; (3) Glasgow Coma Scale (GCS) score = 4-8; (4) head CT examination con rmed spontaneous thalamic hemorrhage breaks into the ventricle, combined ventricular casting, and a Graeb score ≥ 8; (5) anesthesiologists could perform intubation tolerance surgery under general anesthesia; and (6) the patient's family members signed the informed consent form. The exclusion criteria were as follows: (1) brain stem failure, bilateral mydriasis and xation, and inability to maintain vital signs; (2) suspected or con rmed intracranial aneurysms, arteriovenous malformations, tumor, and other causes of secondary intraventricular hemorrhage; and (3) bleeding due to coagulation dysfunction caused by blood diseases, liver diseases, infections, and drugs.…”

Section: Inclusion Criteria and Methodsmentioning

confidence: 99%

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Clinical Efficacy and Safety of Neuroendoscopic Surgery for Severe Ventricular Thalamic Hemorrhage

Zhou

Jiang

Wang

et al. 2021

Preprint

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Objective To summarize and analyze the clinical efficacy and safety of neuroendoscopic surgery in the treatment of patients with severe ventricular thalamic hemorrhage. Methods Eight-three patients with severe ventricular thalamic hemorrhage were treated in the Neurosurgery Department of Anqing Hospital Affiliated to Anhui Medical University from July 2019 to August 2021. Of the 83 patients, 41 underwent neuroendoscopic surgery and 42 underwent simple extraventricular drainage. The hospital stay, GCS scores on the 1st and 14th days postoperatively, the incidence of intracranial infections, and the clearance of postoperative hematomas were compared and analyzed between the two groups. The patients were followed up to 6 months. The prognosis was evaluated by the activity of daily living (ADL) score. A head CT or MRI was obtained to determine whether there was hydrocephalus, cerebral infarction, or other related complications. Results The postoperative hospital stay was 17.42±1.53 days, the GCS score was 6.56±0.21 points on day 1 and 10.83±0.36 points on day 14, intracranial infections occurred in three patients (7.31%) and the hematoma clearance rate was 83.6±5.18% in the neuroendoscopy group, all of which were significantly better than the simple extraventricular drainage group (P < 0.05). After 6 months of follow-up, 28 patients (68.29%) had a good prognosis, 5 patients (12.19%) died, and 4 patients(9.75%)had hydrocephalus in the neuroendoscopy group. In the extraventricular drainage group, the prognosis was good in 15 patients (35.71%), death in 12 patients (28.57%), and hydrocephalus in 17 patients (40.47%). The follow-up results showed that the good prognosis, mortality, and incidence of hydrocephalus in the neuroendoscopy group were significantly better than the extraventricular drainage group (P < 0.05). Conclusion Compared with traditional ventricular-puncture drainage, simultaneous endoscopic sinus surgery for severe ventricular thalamic hemorrhage had a higher hematoma clearance rate, fewer intracranial infections, and hydrocephalus, which together improve the clinical prognosis, and is thus recommended for clinical use.

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Section: Discussionmentioning

confidence: 99%

Section: Inclusion Criteria and Methodsmentioning

confidence: 99%

Clinical Efficacy and Safety of Neuroendoscopic Surgery for Severe Ventricular Thalamic Hemorrhage

Zhou

Jiang

Wang

et al. 2021

Preprint

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“…Rigid endoscopes have a higher image quality and allow an easier insertion and handling of instruments. In contrast, the flexible one allows a flexible mobility of the scope, even though producing a lower image quality [53]. Endoscopic equipment for ETV includes various rigid rod lens Hopkins optics and instruments (scissors, hooks, puncture needles, forceps for tumor biopsy and grasping, bright cold Xenon light source, HD video camera system, irrigation device, and Fogarty balloon catheter) [7].…”

Section: Neuroendoscopic Equipmentmentioning

confidence: 99%

Presentation of the Success Rate of ETV in Distinct Indication Cases of Hydrocephalus

Oertel¹,

Csokonay²

2018

Hydrocephalus - Water on the Brain

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Endoscopic third ventriculostomy (ETV) is an endoscopic fenestration between the floor of the third ventricle and subarachnoid space. It is the procedure of choice for obstructive hydrocephalus (HC). The indication includes obstructive HC caused by aqueduct stenosis, tumors, brain infarction, cystic lesions, hematoma, postinfectious and posthemorrhagic HC, malformation of the fourth ventricle, and further uncommon indications. In this chapter, surgical techniques and the success rate of ETV in distinct indications will be presented and discussed. The overall success rate of ETV is reported at 60-90%. The outcome of the procedure depends highly on the underlying pathology and age. A very favorable outcome is reported in case of aqueduct stenosis (67-93.5%). High success rate is observed in case of cerebellar infarction (86%), tumors (56-81%), and intraventricular cysts (56-95%). In case of intraventricular hemorrhage (43-73%), infection (60-64%), anatomical aberration (21-80%), and communicating HC (65-72%), a significantly inferior success rate is reported. It is well known that ETV has a lower success rate in children (68-71%) compared to adults (70-90%). The overall high clinical success rate in short-term and long-term follow-up confirms that ETV is the gold standard for treatment of occlusive HC. It is effective, safe, and simple.

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“…Rigid and flexible endoscopes are both currently used to perform third ventriculostomy, and each type has distinct advantages and drawbacks. Rigid endoscopes are more commonly used compared with their flexible counterparts because they generally produce higher quality images and allow for easier passing of instruments [ 4 ]. Their use, however, can be restricted by the size of ventricles and made difficult by the rigid linear nature of the rod lenses [ 4 , 5 , 16 , 38 ].…”

Section: Introductionmentioning

confidence: 99%

“…Rigid endoscopes are more commonly used compared with their flexible counterparts because they generally produce higher quality images and allow for easier passing of instruments [ 4 ]. Their use, however, can be restricted by the size of ventricles and made difficult by the rigid linear nature of the rod lenses [ 4 , 5 , 16 , 38 ]. Flexible endoscopes, on the other hand, have an added degree of mobility to help overcome the nonlinear ventricular anatomy.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of flexible versus rigid endoscopic third ventriculostomy in pediatric and adult populations: a systematic review and meta-analysis

et al. 2021

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Endoscopic third ventriculostomy (ETV) is a well-established surgical procedure for hydrocephalus treatment, but there is sparse evidence on the optimal choice between flexible and rigid approaches. A meta-analysis was conducted to compare efficacy and safety profiles of both techniques in pediatrics and adults. A comprehensive search was conducted on PubMED, EMBASE, and Cochrane until 11/10/2019. Efficacy was evaluated comparing incidence of ETV failure, while safety was defined by the incidence of perioperative complications, intraoperative bleedings, and deaths. Random-effects models were used to pool the incidence. Out of 1365 studies, 46 case series were meta-analyzed, yielding 821 patients who underwent flexible ETV and 2918 who underwent rigid ETV, with an age range of [5 days–87 years]. Although flexible ETV had a higher incidence of failure in adults (flexible: 54%, 95%CI: 22–82% vs rigid: 20%, 95%CI: 22–82%) possibly due to confounding due to etiology in adults treated with flexible, a smaller difference was seen in pediatrics (flexible: 36%, pediatric: 32%). Safety profiles were acceptable for both techniques, with a certain degree of variability for complications (flexible 2%, rigid 18%) and death (flexible 1%, rigid 3%) in pediatrics as well as complications (rigid 9%, flexible 13%), death (flexible 4%, rigid 6%) and intra-operative bleeding events (rigid 6%, flexible 8%) in adults. No clear superiority in efficacy could be depicted between flexible and rigid ETV for hydrocephalus treatment. Safety profiles varied by age but were acceptable for both techniques. Well-designed comparative studies are needed to assess the optimal endoscopic treatment option for hydrocephalus.

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Endoscopic Third Ventriculostomy: Outcome Analysis of an Anterior Entry Point

Cited by 15 publications

References 23 publications

Clinical Efficacy and Safety of Neuroendoscopic Surgery for Severe Ventricular Thalamic Hemorrhage

Clinical Efficacy and Safety of Neuroendoscopic Surgery for Severe Ventricular Thalamic Hemorrhage

Presentation of the Success Rate of ETV in Distinct Indication Cases of Hydrocephalus

Efficacy and safety of flexible versus rigid endoscopic third ventriculostomy in pediatric and adult populations: a systematic review and meta-analysis

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