Endoscopic third ventriculostomy: outcome analysis in 368 procedures

Sacko, Oumar; Boetto, S.; Lauwers‐Cancès, Valérie; Dupuy, M.; Roux, Franck‐Emmanuel

doi:10.3171/2009.8.peds08108

Cited by 133 publications

(103 citation statements)

References 29 publications

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“…4 Long-term ETV success rates for this entity of greater than 70% up to around 90% have been reported. 6,9,18 In our study CSF diversion resulted in a significant decrease in ventricular volume and third ventricular width. The inability to demonstrate an effect on ventricular size in patients who underwent shunt treatment was explained by the lack of available preoperative imaging in a large portion of those patients.…”

Section: Discussionmentioning

confidence: 89%

Pediatric tectal plate gliomas: clinical and radiological progression, MR imaging characteristics, and management of hydrocephalus

Griessenauer

Rizk

Miller

et al. 2014

PED

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Object Tectal plate gliomas are generally low-grade astrocytomas with favorable prognosis, and observation of the lesion and management of hydrocephalus remain the mainstay of treatment. Methods A cohort of patients with tectal plate gliomas at 2 academic institutions was retrospectively reviewed. Results Forty-four patients with a mean age of 10.2 years who harbored tectal plate gliomas were included in the study. The mean clinical and radiological follow-up was 7.6 ± 3.3 years (median 7.9 years, range 1.5–14.7 years) and 6.5 ± 3.1 years (median 6.5 years, range 1.1–14.7 years), respectively. The most frequent intervention was CSF diversion (81.8% of patients) followed by biopsy (11.4%), radiotherapy (4.5%), chemotherapy (4.5%), and resection (2.3%). On MR imaging tectal plate gliomas most commonly showed T1-weighted isointensity (71.4%), T2-weighted hyperintensity (88.1%), and rarely enhanced (19%). The initial mean volume was 1.6 ± 2.2 cm3 and it increased to 2.0 ± 4.4 cm3 (p = 0.628) at the last follow-up. Frontal and occipital horn ratio (FOHR) and third ventricular width statistically decreased over time (p < 0.001 and p < 0.05, respectively). Conclusions The authors' results support existing evidence that tectal plate gliomas frequently follow a benign clinical and radiographic course and rarely require any intervention beyond management of associated hydrocephalus.

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Section: Discussionmentioning

confidence: 89%

Pediatric tectal plate gliomas: clinical and radiological progression, MR imaging characteristics, and management of hydrocephalus

Griessenauer

Rizk

Miller

et al. 2014

PED

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“…There is also the element of associated financial cost and the time required to set up these systems in the emergency setting. Furthermore, in several case series, the authors quote a single entry point for ETVs [1][2][3][4][5][6] suggesting a generally accepted surgical practice not to use neuronavigation routinely. In search of an operative planning aid, we have created a mathematical formula that incorporates the target ventricle size using the FHR and computes the location of the optimal ETV entry point.…”

Section: Etv Planning Aid With the Incorporation Of Ventricle Sizementioning

confidence: 99%

“…Endoscopic third ventriculostomy (ETV) is a minimally invasive procedure of cerebrospinal fluid (CSF) diversion widely used for treating hydrocephalus of various etiologies [1][2][3] with a success rate of 68.5-83% [1,[4][5][6]. This technique involves passing a rigid endoscope through the CSF spaces of the ventricular system to access and fenestrate the floor of the third ventricle.…”

Section: Introductionmentioning

confidence: 99%

“…These observations suggest that ETV entry points should be planned on a case-by-case basis with adjustments based on the ventricle sizes [13,14]. Neuronavigation is now wellaccepted in neurosurgical practice, however, it has not been widely used for ETV planning as most studies report using a single conventional transcortical entry point [1,[4][5][6]14]. Furthermore, the infrastructure to this adjunct is not always available to the surgeon.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Operative planning aid for optimal endoscopic third ventriculostomy entry points in pediatric cases

et al. 2017

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Object Endoscopic third ventriculostomy (ETV) uses anatomical spaces of the ventricular system to reach the third ventricle floor and create an alternative pathway for cerebrospinal fluid flow. Optimal ETV trajectories have been previously proposed in the literature, designed to grant access to the third ventricle floor without a displacement of eloquent periventricular structures. However, in hydrocephalus, there is a significant variability to the configuration of the ventricular system, implying that the optimal ETV trajectory and cranial entry point needs to be planned on a case-by-case basis. In the current study, we created a mathematical model, which tailors the optimal ETV entry point to the individual case by incorporating the ventricle dimensions. Methods We retrospectively reviewed the imaging of 30 consecutive pediatric patients with varying degrees of ventriculomegaly. Three dimensional radioanatomical models were created using preoperative MRI scans to simulate the optimal ETV trajectory and entry point for each case. The surface location of cranial entry points for individual ETV trajectories was recorded as Cartesian coordinates centered at Bregma. The distance from the Bregma in the coronal plane represented as Bx^, and the distance from the coronal suture in the sagittal plane represented as By^. The correlation between the ventricle dimensions and the x, y coordinates were tested using linear regression models. Results The distance of the optimal ETV entry point from the Bregma in the coronal plane (Bx^) and from the coronal suture in the sagittal plane (By^) correlated well with the frontal horn ratio (FHR). The coordinates for x and y were fitted along the following linear equations: x = 85.8 FHR−13.3 (r 2 = 0.84, p < 0.001) and y = −69.6 FHR + 16.7 (r 2 = 0.83, p < 0.001). Conclusion The surface location of the optimal cranial ETV entry point correlates well with the ventricle size. We provide the first model that can be used as a surgical planning aid for a case specific ETV entry site with the incorporation of the ventricle size.

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“…34,42 However, cases of loculated hydrocephalus are more complex and challeng- ing. 11 Enlarging loculated components of the ventricular system along with trapped ventricles require fenestration to establish communication between these areas and other compartments within the ventricular system that are able to absorb CSF, or to use a single ventriculoperitoneal shunt catheter.…”

Section: Hydrocephalusmentioning

confidence: 99%

Emerging technology in intracranial neuroendoscopy: application of the NICO Myriad

Dlouhy¹,

Dahdaleh²,

Greenlee³

2011

FOC

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Improvement in fiber optics and imaging paved the way for tremendous advancements in neuroendoscopy. These advancements have led to increasingly widespread use of the endoscope in neurosurgical procedures, which in turn incited a technological revolution leading to new approaches, instruments, techniques, and a diverse armamentarium for the treatment of a variety of neurosurgical disorders. Soft-tissue removal is often a rate-limiting aspect to endoscopic procedures, especially when the soft tissue is dense or fibrous. The authors review a series of cases involving patients treated between August 2009 and October 2010 with a new device (the NICO Myriad), a non–heat-generating, oscillating, cutting, and tissue removal instrument that can be used through the working channel of the endoscope as well as in open neurosurgical procedures. They used this device in 14 purely endoscopic intracranial procedures and 1 endoscope-assisted keyhole craniotomy. They report that the device was easy to use and found that tissue resection was more efficient than with other available endoscopic instruments, especially in the resection of fibrotic tissue. There were no observed device-related complications. The authors discuss the technical aspects of using this device in endoscopic resection of pituitary tumors, craniopharyngiomas, and colloid cysts. They also demonstrate its use in hydrocephalus and intraventricular clot removal and discuss its potential use in other neurosurgical disorders.

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Endoscopic third ventriculostomy: outcome analysis in 368 procedures

Cited by 133 publications

References 29 publications

Pediatric tectal plate gliomas: clinical and radiological progression, MR imaging characteristics, and management of hydrocephalus

Pediatric tectal plate gliomas: clinical and radiological progression, MR imaging characteristics, and management of hydrocephalus

Operative planning aid for optimal endoscopic third ventriculostomy entry points in pediatric cases

Emerging technology in intracranial neuroendoscopy: application of the NICO Myriad

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