Influence of Neuroendoscopic Third Ventriculostomy on the Size of Ventricles in Chronic Hydrocephalus

Abstract

Our intention was to compare the clinical outcome after surgical treatment of chronic hydrocephalus between patients who were subjected to neuroendoscopic third ventriculostomy and patients who underwent shunt implantation. At the Department of Neurosurgery of the Research Institute of Polish Mothers' Memorial Hospital from 1999 to 2001, 29 children, of an average age of 7 years (+/-7.1 years SD), underwent successful neuroendoscopic procedures, and from 1992 to 1994, 59 children, of an average age of 2 months (+/-1.9 months SD), underwent shunt implantation. The size of the ventricular system was described by the Frontal Horn Index and its change after operative procedures by the ratio of the final to the primary Frontal Horn Index. Head circumference was measured in percentiles according to the Kurniewicz-Witczakowa chart for Polish children. The reduction in head circumference after a neuroendoscopic procedure was, on average, significantly less than after a shunt implantation (0.39 percentiles +/-29.6 SD vs 17.93 percentiles +/-19.93 SD). Concerning the change in ventricular size after a neuroendoscopic procedure, it was noticed that the average ratio of the final to the primary Frontal Horn Index was 0.9. Meanwhile, the same parameter after a shunt implantation was 0.55. Based on the values of the Frontal Horn Indexes, it was observed that the ventricular system in infants after neuroendoscopic procedures was significantly larger than in other age groups (0.7 vs 0.5). After successful neuroendoscopic operations in a group of children suffering from Chiari II malformation, ventricular systems were slightly enlarged. The ratio of the final Frontal Index to the primary Frontal Horn Index was 1.31. In children suffering from chronic hydrocephalus, the average reduction in the size of the ventricular system and the rate of head circumference growth are lower after neuroendoscopic operations than after shunt implantations. Successful neuroendoscopic procedures are characterized by, on average, a higher rate of head circumference growth in infants than in neonates. In addition, the rate of head circumference growth after successful neuroendoscopic procedures could be higher than before the operation, which is clearly visible in children suffering from Chiari II malformation, but it does not mean a constant increase of that parameter during the postoperative period.

The Global Rise of Endoscopic Third Ventriculostomy with Choroid Plexus Cauterization in Pediatric Hydrocephalus

“…However, the factors weighed by a given surgeon to determine whether to perform an additional hydrocephalus intervention are not clearly defined. The ventricles of successfully shunted infants with hydrocephalus reliably decrease in size postoperatively [40,41] . But studies have shown the ventricles of young children following ETV may not significantly decrease in size, despite resolution of clinical features of hydrocephalus [42] .…”

Endoscopic third ventriculostomy with choroid plexus cauterization outcome: distinguishing success from failure

“…For hydrocephalus that is successfully shunted, ventricular volume reliably decreases, while the head circumference trajectory typically decreases or plateaus. 8,10 As a reference procedure, shunting augments CSF dynamics in a completely different manner from that of endoscopic treatment, and, therefore, the same metrics used for assessment of success may change in different magnitudes. On the other hand, following a successful ETV in older children, preoperative symptoms often improve but the ventricular volume may not decrease.…”

Longitudinal comparison of diffusion tensor imaging parameters and neuropsychological measures following endoscopic third ventriculostomy for hydrocephalus

“…Endoscopic third ventriculostomy often results in stability or, in some cases, an increase in ventricular size. 20,23 This report shows for the first time improvements in white matter tract DTI parameters and strong intellectual development following ETV, despite minimal change in ventricular size—although, notably, the third ventricular morphology index improved. We believe this report provides additional support for the role of DTI as a candidate biomarker of subtle neurobehavioral and cognitive deficits not evident on clinical examination.…”