Neuroendoscopic Third Ventriculostomy in Patients Less than 1 Year Old

Buxton, Neil; Macarthur, Donald; Mallucci, Conor; Punt, Jonathan; Vloeberghs, Michael

doi:10.1159/000028693

Cited by 207 publications

(133 citation statements)

References 16 publications

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“…The complication rate of 11% encountered in this study fits well within the 6 to 20% range of complication rates reported in the literature (17). Although several serious and fatal complications have been reported including intraoperative venous or arterial bleeding, seizures, CSF leakage, infection, oculomotor nerve palsy, bradycardia, temperature regulation disturbance, diabetes insipidus, syndrome of inappropriate antidiuretic hormone, basilar artery perforation or traumatic aneurysm, subarachnoid, and subdural hematoma (2, 3,4,10,11,14,23,25), the complications of ETV in the majority of cases are usually clinically insignificant.…”

Section: A B C Azab W Et Al: Preoperative Endoscopic Third Ventriculsupporting

confidence: 85%

Preoperative endoscopic third ventriculostomy in children with posterior fossa tumors: an institution experience

Azab¹,

Alsheikh²,

Yahia³

2012

Turkish Neurosurgery

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AIm:To assess the effectiveness and safety of pre-resection endoscopic third ventriculostomy (ETV) in permanently relieving hydrocephalus in children with posterior fossa tumors. mAterIAl and methOds: 17 pediatric patients with posterior fossa tumors and associated triventricular obstructive hydrocephalus underwent ETV before definitive tumor resection, and ETV was repeated after tumor resection if hydrocephalus with increased intracranial pressure persisted or recurred. The medical records, operative notes and imaging studies were retrospectively reviewed.results: 18 ETV procedures were performed in 17 patients, consisting of 11 males and 6 females, age range (1.5 to 13 years; mean 6±3.86). Follow-up periods ranged from 6 to 23 months (mean follow-up 13.9±5.4 months). ETV was successful in relieving hydrocephalus during the follow-up period in 15 out of 17 patients (88.2%). Prior to surgical excision of the posterior fossa tumors, no failures of ETV were detected and all of the 17 patients showed marked clinical improvement and radiological disappearance of signs of active hydrocephalus.COnClusIOn: Preoperative ETV is a highly effective long-term CSF diversion procedure for treatment of hydrocephalus associated with posterior fossa tumors in children. In experienced hands, ETV has a very low complication rate.KeywOrds: Hydrocephalus, Endoscopic third ventriculostomy, Posterior fossa tumor ÖZ AmAÇ: Posterior fossa tümörlü çocuklarda hidrosefaliyi kalıcı olarak tedavi etmek üzere rezeksiyon öncesi endoskopik üçüncü ventrikülosto-minin (ETV) etkinlik ve güvenliğini değerlendirme. yÖntem ve GereÇler: Posterior fossa tümörlü ve ilişkili triventriküler obstrüktif hidrosefalili 17 pediatrik hastada kesin tümör rezeksiyonu öncesinde ETV yapıldı ve ETV işlemi eğer artmış intrakraniyal basınçlı hidrosefali devam ediyorsa veya tekrarlarsa tümör rezeksiyonu sonrasında tekrarlandı. Tıbbi kayıtlar, ameliyat notları ve görüntüleme çalışmaları retrospektif olarak gözden geçirildi.BulGulAr: Yaş aralığı 1,5-13 yıl (ortalama 6±3,86) olan ve 11 erkek ve 6 kadından oluşan 17 hastada 18 ETV işlemi yapıldı. Takip dönemleri 6 ile 23 ay arasındaydı (ortalama takip 13,9±5,4 ay). ETV, takip döneminde 17 hastanın 15'inde (%88,2) hidrosefaliyi tedavi etmekte başarılıydı. Posterior fossa tümörlerinin cerrahi insizyonu öncesinde herhangi bir ETV başarısızlığı saptanmadı ve 17 hastanın tümünde belirgin klinik iyileşme ve aktif hidrosefali bulgularının radyolojik olarak kaybolması görüldü. sOnuÇ: Preoperatif ETV çocuklarda posterior fossa tümörleriyle ilişkili hidrosefalinin tedavisinde çok etkin, uzun dönemli bir BOS dİversiyonu işlemidir. Deneyimli ellerde, ETV'nin komplikasyon oranı çok düşüktür AnAhtAr sÖZCÜKler: Hidrosefali, Endoskopik üçüncü ventrikülostomi, Posterior fossa tümörü

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Section: A B C Azab W Et Al: Preoperative Endoscopic Third Ventriculsupporting

confidence: 85%

Preoperative endoscopic third ventriculostomy in children with posterior fossa tumors: an institution experience

Azab¹,

Alsheikh²,

Yahia³

2012

Turkish Neurosurgery

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“…Other works, such as those of Buxton et al [60], Kadrian et al [61] and Koch-Wiewrodt et al [62] as referred to in Spennato et al [56], reported the opposite extreme of success rates below 30% in infants and considered an age under one year to be a contraindication for ETV.…”

Section: Discussionmentioning

confidence: 95%

Endoscopic third ventriculostomy in the management of hydrocephalus: Outcome analysis of 168 consecutive procedures

Salvador

Oliveira

Pereira

et al. 2014

Clinical Neurology and Neurosurgery

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a b s t r a c tBackground: Endoscopic third ventriculostomy (ETV) is the treatment of choice for obstructive hydrocephalus, but the outcome is still controversial in terms of age and aetiology. Methods: Between 1998 and 2011, 168 consecutive procedures were performed in 164 patients, primarily children (56% < 18 years of age and 35% < 2 years of age). The causes of obstructive hydrocephalus included tumoural pathology, Chiari malformation, congenital obstruction of the aqueduct, post-infectious and post-haemorrhagic membranes, and ventriculo-peritoneal shunt (VPS) malfunctions. Successful ETV was defined by the resolution of symptoms and the avoidance of a shunt. Results: ETV was successful in 75.6% of patients, but 19% of the patients required VPS in the first month after ETV, and 5.4% required a VPS more than one month after ETV. Four patients were ultimately submitted for second ETVs. In this series, no major permanent morbidity or mortality was observed. Conclusions: ETV is a safe procedure and an effective treatment for obstructive hydrocephalus even following the dysfunction of previous VPSs and in children younger than two years.

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“…1,3 The success rate of ETV/CPC in children younger than 2 years varies from less than 50% to as high as 80% depending on the etiology of hydrocephalus. 1,4,13 In a large cohort of Ugandan children with postinfectious hydrocephalus, Warf found that adding CPC to ETV increased the success rate from 47% to 66%. 23 In the existing literature, the success rate of ETV/CPC for the PHHP population is reported to be 10%-44%.…”

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confidence: 99%

Endoscopic third ventriculostomy and choroid plexus cauterization in posthemorrhagic hydrocephalus of prematurity

Chamiraju

Bhatia

Sandberg

et al. 2014

PED

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Object The aim of this study was to determine the role of endoscopic third ventriculostomy and choroid plexus cauterization (ETV/CPC) in the management of posthemorrhagic hydrocephalus of prematurity (PHHP) and to analyze which factors affect patient outcomes. Methods This study retrospectively reviewed medical records of 27 premature infants with intraventricular hemorrhage (IVH) and hydrocephalus treated with ETV and CPC from 2008 to 2011. All patients were evaluated using MRI before the procedure to verify the anatomical feasibility of ETV/CPC. Endoscopic treatment included third ventriculostomy, septostomy, and bilateral CPC. After ETV/CPC, all patients underwent follow-up for a period of 6–40 months (mean 16.2 months). The procedure was considered a failure if the patient subsequently required a shunt. The following factors were analyzed to determine a relationship to patient outcomes: gestational age at birth, corrected age and weight at surgery, timing of surgery after birth, grade of IVH, the status of the prepontine cistern and cerebral aqueduct on MRI, need for a ventricular access device prior to the endoscopic procedure, and scarring of the prepontine cistern noted at surgery. Results Seventeen (63%) of 27 patients required a shunt after ETV/CPC, and 10 patients did not require further CSF diversion. Several factors studied were associated with a higher rate of ETV/CPC failure: Grade IV hemorrhage, weight 3 kg or less and age younger than 3 months at the time of surgery, need for reservoir placement, and presence of a normal cerebral aqueduct. Two factors were found to be statistically significant: the patient's corrected gestational age of less than 0 weeks at surgery and a narrow prepontine cistern on MRI. The majority (83%) of ETV/CPC failures occurred in the first 3 months after the procedure. None of the patients had a complication directly related to the procedure. Conclusions Endoscopic third ventriculostomy/CPC is a safe initial procedure for hydrocephalus in premature infants with IVH and hydrocephalus, obviating the need for a shunt in selected patients. Even though the success rate is low (37%), the lower rate of complications in comparison with shunt treatment may justify this procedure in the initial management of hydrocephalus. As several of the studied factors have shown influence on the outcome, patient selection based on these observations might increase the success rate.

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Neuroendoscopic Third Ventriculostomy in Patients Less than 1 Year Old

Cited by 207 publications

References 16 publications

Preoperative endoscopic third ventriculostomy in children with posterior fossa tumors: an institution experience

Preoperative endoscopic third ventriculostomy in children with posterior fossa tumors: an institution experience

Endoscopic third ventriculostomy in the management of hydrocephalus: Outcome analysis of 168 consecutive procedures

Endoscopic third ventriculostomy and choroid plexus cauterization in posthemorrhagic hydrocephalus of prematurity

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