Endoscopic Third Ventriculostomy : Success and Failure

Deopujari, Chandrashekhar; Karmarkar, Vikram; Shaikh, Salman

doi:10.3340/jkns.2017.0202.013

Cited by 35 publications

(36 citation statements)

References 54 publications

(57 reference statements)

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“…Advancements in the diagnosis and treatment of hydrocephalus have rapidly improved over the last century [ 12 ]. From the first attempt to create a permanent ventriculo-subarachnoid-subgaleal CSF diversion by Mikulicz in 1893, to the first functional valve implantation devised by Nulsen and Spitz in 1949, the basis of treatment for hydrocephalus has largely remained the same [ 13 , 14 ]. In spite of several innovations and technical modifications, shunts, which have evolved and matured to become the standard of care for all types of hydrocephalus, are not without complications [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

The Current State of Clinical Trials Studying Hydrocephalus: An Analysis of ClinicalTrials.gov

Abraham

Povolotskiy

Gold

et al. 2020

Cureus

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Introduction Hydrocephalus is a significant public health concern estimated to affect 380,000 new individuals annually. In addition, it exhibits an increasingly high financial burden for the healthcare industry. Clinical trials are the gold standard for evaluating preventative and therapeutic strategies to bring potential treatments to the forefront of clinical practice. Methods A study of the ClinicalTrials.gov was conducted in April 2019 to examine all current and previously reported clinical trials studying hydrocephalus. Studies were reviewed to extrapolate information to characterize the current state of research being conducted for hydrocephalus. Results In total, 80 clinical trials met inclusion criteria and were analyzed: 48.8% were observation and 51.2% were interventional. Of those, 55% have been completed while 30.0% are still recruiting, and 15.0% are not yet recruiting. The United States has the most clinical trials (42.0%) and a plurality of trials has a sample size of 0-50 participants. The majority of studies included only adults (53.8%). Of those studies, 54.0% were cohort and the majority were prospective (74.0%). Of the different types of hydrocephalus, normal pressure hydrocephalus and pediatric hydrocephalus have generated the most interest for research comprising a majority of the clinical trial registry. While 44 of the trials are complete, only 20 have published results in peer-reviewed literature highlighting the need for improvement in publishing study results even if the results of the trials are null. Conclusion Most clinical trials to date have pertained to the treatment of normal pressure hydrocephalus and pediatric hydrocephalus. While great advancements have been made for the treatment of hydrocephalus, there remains much room for improvements in therapeutic interventional modalities as well as ensuring the reporting of all undertaken clinical trials.

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Section: Discussionmentioning

confidence: 99%

The Current State of Clinical Trials Studying Hydrocephalus: An Analysis of ClinicalTrials.gov

Abraham

Povolotskiy

Gold

et al. 2020

Cureus

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“…Success of ETV has been determined in many publications as; avoiding a shunt in a patient who would otherwise require one. Most authors would classify ETV as successful if a patient later shows clinical evidence of normal intracranial pressure (ICP) and structural evidence of stable or decreased ventricular size (2, 5, 6, 15, 24).…”

Section: Discussionmentioning

confidence: 99%

The Scanty Knowledge of Endoscopic Third Ventriculostomy in Infants

Alqroom¹,

Al-Khawaldeh²,

Makhamreh³

et al. 2019

Med Arch

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Introduction: Hydrocephalus (HCP) remains one of the commonest pathologies treated in developing countries. Endoscopic third ventriculostomy (ETV) has become the alternative to shunt-divergen procedures in the treatment of many pathologies of the cerebral fluid in the brain. Age has been considered a limitation to perform the procedure, we started to perform ETV In younger patients earlier than many other units. Objectives: In this study, we demonstrate the overall efficacy of ETV in infants younger than 1-year of age and to subsequently report the outcome of this procedure. Methods: From 2000 till 2016 we have performed a total of 386 cases of ETV of all ages. 71-cases were infants (below 1-year of age). Our study was undertaken to evaluate these cases. Patients were divided into two subgroups according to the cause of hydrocephalus; obstructive HCP, communicating HCP. Results: Mean time for follow up was 52 months. Mean age at surgery was 137days (7- 351days). The population included 31-females and 40-males, while10 infants were premature. Success rates were; 91.6%, 63.6% correspond to each sub-group with an overall success rate of 73.24%. Conclusion: ETV in infants is feasible, technically more demanding. Success rate justifies the procedure to be performed in such age group of patients. ETV can be used, attentively, in cases of hydrocephalus associated with MMC, morbidity and mortality does not differ from the general population.

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“…Secondary ETV is an effective, safe and justifiable treatment option for obstructive hydrocephalus due to either shunt malfunction or failure of primary ETV. ETV implementation in such cases carries a strong possibility of further shunt independence or at the least pushes further the need for subsequent intervention [30]. Due to the possibility of late ETV stoma closure, long-term follow-up of these patients is essential.…”

Section: Resultsmentioning

confidence: 99%

Role of Secondary Endoscopic Third Ventriculostomy in Children: Review of an Institutional Experience

et al. 2019

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Background: Endoscopic third ventriculostomy (ETV) has become a standard and safe procedure for obstructive hydrocephalus. ETV can also play an important role in children presenting with shunt malfunction with an added advantage of shunt independence. Secondary ETV can be defined as either a redo endoscopic ventriculostomy done after primary ETV stoma closure or that done in cases presenting with shunt malfunction. Objective: The aim of our study was to evaluate the role of secondary ETV in the pediatric age group patients. Methods: This is a retrospective analysis of 36 children (<18 years) who underwent ETV after shunt malfunction and 4 children with ETV done after previous ETV stoma closure from 2004 until 2018. In all patients, the obstructive pattern suggesting aqueduct outflow obstruction was observed on MRI. Patients were followed up for a mean period of 4.25 years. Results: ETV was considered successful if the patient avoided a shunt insertion later on in their life. Considering this definition, a success rate of 72% was observed with secondary ETV for shunt malfunction whereas a success rate of 75% was observed after primary ETV failure without any major side effects in any of the patients. Conclusion: ETV can be considered a primary treatment modality in children with shunt malfunction and has a good success rate in cases presenting with closure of previously performed ETV stoma.

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Endoscopic Third Ventriculostomy : Success and Failure

Cited by 35 publications

References 54 publications

The Current State of Clinical Trials Studying Hydrocephalus: An Analysis of ClinicalTrials.gov

The Current State of Clinical Trials Studying Hydrocephalus: An Analysis of ClinicalTrials.gov

The Scanty Knowledge of Endoscopic Third Ventriculostomy in Infants

Role of Secondary Endoscopic Third Ventriculostomy in Children: Review of an Institutional Experience

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