Neuroendoscopic third ventriculostomy for hydrocephalus in adults: report of a single unit’s experience with 63 cases

Buxton, Neil; Ho, Kang Jung; Macarthur, Donald; Vloeberghs, Michael; Punt, Jonathan; Robertson, Iain

doi:10.1016/s0090-3019(01)00352-4

Cited by 108 publications

(65 citation statements)

References 12 publications

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“…Although a series by Dusick et al in 2008 failed to find any association between a history of prior shunting and outcomes after ETV, 10 patients who received a secondary ETV in our study had a higher rate of symptom recurrence (46.2% vs 17.2%, p = 0.003), as well as surgical revision (43.6% vs 15.6%, p = 0.003), compared 4 Interestingly, the 39 patients who received a secondary ETV in our study received a median of 5 (2-9) shunt revisions prior to ETV. Whereas no significant difference was observed in the complication rate between patients who received a primary versus secondary ETV in our study, Hader et al found that major complications after ETV occurred more frequently in patients who underwent a secondary ETV (14 of 45 patients, 31%) compared with a primary ETV (7 of 86 patients, 8%) (p = 0.02).…”

Section: Discussioncontrasting

confidence: 74%

Lower rates of symptom recurrence and surgical revision after primary compared with secondary endoscopic third ventriculostomy for obstructive hydrocephalus secondary to aqueductal stenosis in adults

Sankey¹,

Goodwin²,

Jusué-Torres³

et al. 2016

JNS

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E ndoscopic third ventriculostomy (ETV) is considered the initial treatment of choice for obstructive hydrocephalus, with significant improvement reported in more than 75% of hydrocephalus secondary to aqueductal stenosis and approximately 95% of outflow obstruction of the third ventricle caused by space-occupying lesions. 10,16,23 ETV is also the preferred treatment for symptomatic congenital aqueductal stenosis, as well as a viable option for patients whose aqueductal stenosis is acquired. 16 Overall, the largest adult series have displayed success rates ranging from 66% to 88% in hydrocephalus management. 10 However, the success of ETV in patients obJective Endoscopic third ventriculostomy (ETV) is the treatment of choice for obstructive hydrocephalus; however, the success of ETV in patients who have previously undergone shunt placement remains unclear. The present study analyzed 103 adult patients with aqueductal stenosis who underwent ETV for obstructive hydrocephalus and evaluated the effect of previous shunt placement on post-ETV outcomes. methods This study was a retrospective review of 151 consecutive patients who were treated between 2007 and 2013 with ETV for hydrocephalus. One hundred three (68.2%) patients with aqueductal stenosis causing obstructive hydrocephalus were included in the analysis. Postoperative ETV patency and aqueductal and cisternal flow were assessed by high-resolution, gradient-echo MRI. Post-ETV Mini-Mental State Examination, Timed Up and Go, and Tinetti scores were compared with preoperative values. Univariate and multivariate analyses were performed comparing the post-ETV outcomes in patients who underwent a primary (no previous shunt) ETV (n = 64) versus secondary (previous shunt) ETV (n = 39). results The majority of patients showed significant improvement in symptoms after ETV; however, no significant differences were seen in any of the quantitative tests performed during follow-up. Symptom recurrence occurred in 29 (28.2%) patients after ETV, after a median of 3.0 (interquartile range 0.8-8.0) months post-ETV failure. Twenty-seven (26.2%) patients required surgical revision after their initial ETV. Patients who received a secondary ETV had higher rates of symptom recurrence (p = 0.003) and surgical revision (p = 0.003), particularly in regard to additional shunt placement/revision post-ETV (p = 0.005). These differences remained significant after multivariate analysis for both symptom recurrence (p = 0.030) and surgical revision (p = 0.043). coNclusioNs Patients with obstructive hydrocephalus due to aqueductal stenosis exhibit symptomatic improvement after ETV, with a relatively low failure rate. Patients with a primary history of shunt placement who undergo ETV as a secondary intervention are at increased risk of symptom recurrence and need for surgical revision post-ETV.

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Section: Discussioncontrasting

confidence: 74%

Lower rates of symptom recurrence and surgical revision after primary compared with secondary endoscopic third ventriculostomy for obstructive hydrocephalus secondary to aqueductal stenosis in adults

Sankey¹,

Goodwin²,

Jusué-Torres³

et al. 2016

JNS

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“…Other authors suggested that re-ETV should be considered if closure of the ventriculostomy site by gliosis and scarring is found during the second neuroendoscopic procedure. 6,8,11,46,54 …”

Section: 50mentioning

confidence: 99%

Endoscopic third ventriculostomy and repeat endoscopic third ventriculostomy in pediatric patients: the Dutch experience

Breimer

Dammers

Woerdeman

et al. 2017

Journal of Neurosurgery: Pediatrics

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OBJECTIVEAfter endoscopic third ventriculostomy (ETV), some patients develop recurrent symptoms of hydrocephalus. The optimal treatment for these patients is not clear: repeat ETV (re-ETV) or CSF shunting. The goals of the study were to assess the effectiveness of re-ETV relative to initial ETV in pediatric patients and validate the ETV success score (ETVSS) for re-ETV.METHODSRetrospective data of 624 ETV and 93 re-ETV procedures were collected from 6 neurosurgical centers in the Netherlands (1998–2015). Multivariable Cox proportional hazards modeling was used to provide an adjusted estimate of the hazard ratio for re-ETV failure relative to ETV failure. The correlation coefficient between ETVSS and the chance of re-ETV success was calculated using Kendall’s tau coefficient. Model discrimination was quantified using the c-statistic. The effects of intraoperative findings and management on re-ETV success were also analyzed.RESULTSThe hazard ratio for re-ETV failure relative to ETV failure was 1.23 (95% CI 0.90–1.69; p = 0.20). At 6 months, the success rates for both ETV and re-ETV were 68%. ETVSS was significantly related to the chances of re-ETV success (τ = 0.37; 95% bias corrected and accelerated CI 0.21–0.52; p < 0.001). The c-statistic was 0.74 (95% CI 0.64–0.85). The presence of prepontine arachnoid membranes and use of an external ventricular drain (EVD) were negatively associated with treatment success, with ORs of 4.0 (95% CI 1.5–10.5) and 9.7 (95% CI 3.4–27.8), respectively.CONCLUSIONSRe-ETV seems to be as safe and effective as initial ETV. ETVSS adequately predicts the chance of successful re-ETV. The presence of prepontine arachnoid membranes and the use of EVD negatively influence the chance of success.

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“…After surgical resection of the tumor and re-establishment of CSF pathways, the need for permanent shunting might be avoided, unless the patient continues to have hydrocephalus. In addition, a third ventriculostomy can be useful in patients with noncommunicating hydrocephalus [25]. The surgical approaches for these lateral ventricular tumors include transcortical-transventricular and interhemispheric transcallosal-transventricular routes.…”

Section: Treatment Options and Outcomementioning

confidence: 99%

Central neurocytoma: A clinical, radiological and pathological study of nine cases

Chen¹,

Shen²,

Wang³

et al. 2008

Clinical Neurology and Neurosurgery

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Purpose-Central neurocytoma is a rare intraventricular brain tumor that affects young adults and presents with increased intracranial pressure secondary to obstructive hydrocephalus. Typically, it has a favorable prognosis after adequate surgical intervention, but in some cases the clinical course is more aggressive. In this report, we describe the diagnosis and treatment of central neurocytoma in a series of patients at our institution.Patients and Methods-Our series of nine patients (M:F=2:7, mean age, 28.2 years) with ventricular tumors showed typical radiological, histologic and immunohistochemical features of central neurocytoma. Most patients received craniotomy with removal of the tumor through transcallosal or transcortical approach. The surgical and histopathologic data of these patients were reviewed and analyzed.Results-The prognosis is generally favorable. Although most patients were alive and well at the last follow-up, two developed recurrence. Typical histologic features of recurrent neurocytoma include high proliferative activity (MIB-1 labeling index: 2.0-6.8%), prominent vascular proliferation and remarkable synaptophysin expression. Two patients (non-recurrent) died during follow-up due to sepsis or central failure. The MIB-1 labeling indices were as high as 2.2-5.4% for these two patients.Conclusion-Although central neurocytoma is generally a benign neoplasm, some variant forms of recurrence are also present. Complete resection provides favorable long-term prognosis in most cases. Recurrent tumors are often local and the patients seem to recover well after a second resection followed by radiotherapy. Histologic features such as tumor proliferation (MIB-1 labeling index), vascular proliferation, and synaptophysin expression are often prominent in the recurrent tumor. We recommend that these histologic features be considered for tumor recurrence during treatment and follow-up of these patients.

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Neuroendoscopic third ventriculostomy for hydrocephalus in adults: report of a single unit’s experience with 63 cases

Cited by 108 publications

References 12 publications

Lower rates of symptom recurrence and surgical revision after primary compared with secondary endoscopic third ventriculostomy for obstructive hydrocephalus secondary to aqueductal stenosis in adults

Lower rates of symptom recurrence and surgical revision after primary compared with secondary endoscopic third ventriculostomy for obstructive hydrocephalus secondary to aqueductal stenosis in adults

Endoscopic third ventriculostomy and repeat endoscopic third ventriculostomy in pediatric patients: the Dutch experience

Central neurocytoma: A clinical, radiological and pathological study of nine cases

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