The role of endoscopic third ventriculostomy in the treatment of hydrocephalus

Vogel, Timothy W.; Bahuleyan, Biji; Robinson, Shenandoah; Cohen, Alan R.

doi:10.3171/2013.4.peds12481

Cited by 67 publications

(36 citation statements)

References 33 publications

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“…1, 3,5,7,8,16,18,24 Other means of predicting ETV success have also been postulated, including preoperative predictors, 1 radiological predictors, 6 and intraoperative predictors. 9 We found, on univariate analysis only, that a larger ostomy size and the presence of a naked basilar artery were predictive of 6-month ETV success.…”

Section: Discussionmentioning

confidence: 99%

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Endoscopic third ventriculostomy in children: prospective, multicenter results from the Hydrocephalus Clinical Research Network

Kulkarni

Riva-Cambrin

Holubkov

et al. 2016

PED

107

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OBJECTIVE Endoscopic third ventriculostomy (ETV) is now established as a viable treatment option for a subgroup of children with hydrocephalus. Here, the authors report prospective, multicenter results from the Hydrocephalus Clinical Research Network (HCRN) to provide the most accurate determination of morbidity, complication incidence, and efficacy of ETV in children and to determine if intraoperative predictors of ETV success add substantially to preoperative predictors. METHODS All children undergoing a first ETV (without choroid plexus cauterization) at 1 of 7 HCRN centers up to June 2013 were included in the study and followed up for a minimum of 18 months. Data, including detailed intraoperative data, were prospectively collected as part of the HCRN's Core Data Project and included details of patient characteristics, ETV failure (need for repeat hydrocephalus surgery), and, in a subset of patients, postoperative complications up to the time of discharge. RESULTS Three hundred thirty-six eligible children underwent initial ETV, 18.8% of whom had undergone shunt placement prior to the ETV. The median age at ETV was 6.9 years (IQR 1.7–12.6), with 15.2% of the study cohort younger than 12 months of age. The most common etiologies were aqueductal stenosis (24.8%) and midbrain or tectal lesions (21.2%). Visible forniceal injury (16.6%) was more common than previously reported, whereas severe bleeding (1.8%), thalamic contusion (1.8%), venous injury (1.5%), hypothalamic contusion (1.5%), and major arterial injury (0.3%) were rare. The most common postoperative complications were CSF leak (4.4%), hyponatremia (3.9%), and pseudomeningocele (3.9%). New neurological deficit occurred in 1.5% cases, with 0.5% being permanent. One hundred forty-one patients had documented failure of their ETV requiring repeat hydrocephalus surgery during follow-up, 117 of them during the first 6 months postprocedure. Kaplan-Meier rates of 30-day, 90-day, 6-month, 1-year, and 2-year failure-free survival were 73.7%, 66.7%, 64.8%, 61.7%, and 57.8%, respectively. According to multivariate modeling, the preoperative ETV Success Score (ETVSS) was associated with ETV success (p < 0.001), as was the intraoperative ability to visualize a “naked” basilar artery (p = 0.023). CONCLUSIONS The authors' documented experience represents the most detailed account of ETV results in North America and provides the most accurate picture to date of ETV success and complications, based on contemporaneously collected prospective data. Serious complications with ETV are low. In addition to the ETVSS, visualization of a naked basilar artery is predictive of ETV success.

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Section: Discussionmentioning

confidence: 99%

“…1, 3,5,7,8,16,18,24 In some cases, a definitive etiology for the hydrocephalus could not be identified. Although the ETVSS does include an etiology category for "other," for our analysis, we did not calculate an ETVSS for patients without a clearly defined etiology.…”

Section: Populationmentioning

confidence: 99%

Endoscopic third ventriculostomy in children: prospective, multicenter results from the Hydrocephalus Clinical Research Network

Kulkarni

Riva-Cambrin

Holubkov

et al. 2016

PED

107

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“…These include ETV and septostomy, options that are most suitable for treating those patients with obstructive hydrocephalus. [20][21][22][23][24][25][26][27][28][29][30] ETV consists of creating a hole through the tuber cinereum in the floor of the third ventricle to allow CSF to flow into the interpeduncular and prepontine cisterns, thereby bypassing obstructions in the aqueductal area, 21,31-40 whereas septostomy involves placing the hole in the septum pellucidum. Another postulated mechanism involves the restoration of the pulsatility of ventricular walls as a result of the stoma, an effect that may help restore CSF dynamics by driving CSF flow from the ventricular system into the subarachnoid space.…”

Section: Hydrocephalusmentioning

confidence: 99%

Comparison of Intracranial Neuroendoscopic Procedures in Children versus Adults

Girgis

Diaz

Hader

et al. 2015

Can. J. Neurol. Sci.

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Background: The emphasis regarding intracranial neuroendoscopy has been traditionally advocated and focused on the role in pediatric patients, although a significant usage has developed in adult patients. In this study, we examine and contrast the role of predominantly intracranial neuroendoscopy in both a pediatric and adult population with a minimum postprocedure follow-up of 5 years. Methods: A retrospective review was conducted for patients in the two hospitals that manage neurosurgical care for Southern Alberta, Canada, undergoing neuroendoscopic surgery between 1994 and 2008. The pediatric group was defined as age ≤17 years and the adult group as age ≥18 years. Results: A total of 273 patients who underwent a total of 330 procedures with a mean postprocedure follow-up of 12.9 years were identified. There were 161 adult and 112 pediatric patients, and both groups underwent surgery by the same surgeons. The most common procedure was endoscopic third ventriculostomy, accounting for 55% of procedures. One postoperative death occurred in an adult patient. Endoscopic third ventriculostomy success 1-year postprocedure was 81%, with only three late-term failures. Postoperative infection was the most common serious complication (two pediatric/four adult patients). Adult and pediatric patients had similar major complication rates (4.2% vs 5.7%, p = 0.547). Conclusions: Neuroendoscopy overall had a similar role in both pediatric and adult neurosurgical populations, with the most commonly associated complication being infection. Neuroendoscopy is an important therapeutic modality in the management of appropriate adult patients.RÉSUMÉ: Comparaison des interventions neuroendoscopiques intracrâniennes chez les enfants et chez les adultes. Contexte: Traditionnellement, l'emphase a été mise sur la neuroendoscopie intracrânienne chez les enfants et sur son rôle dans cette population de patients. Cependant, de telles interventions sont de plus en plus pratiquées chez des adultes. Nous examinons le rôle de la neuroendoscopie tant chez les enfants que chez les adultes et nous comparons son rôle dans ces deux populations de patients. Méthode: Nous avons procédé à une revue rétrospective des dossiers de patients ayant subi une chirurgie par neuroendoscopie entre 1994 et 2008 dans deux hôpitaux qui offrent des soins neurochirurgicaux dans la partie sud de l'Alberta, au Canada. Les patients du groupe pédiatrique étaient âgés de 17 ans ou moins et ceux du groupe adulte de 18 ans ou plus. Le suivi le plus court après l'intervention était de 5 ans. Résultats: Nous avons identifié 273 patients, dont 161 adultes et 112 enfants, qui ont subi au total 330 interventions, et chez qui un suivi moyen de 12,9 ans était disponible. Les deux groupes de patients ont été opérés par les mêmes chirurgiens. L'intervention la plus fréquemment effectuée était la ventriculostomie au niveau du 3e ventricule, ce qui représentait 5% des interventions. Un patient adulte est décédé en période post-opératoire. La ventriculostomie du 3e ventricule p...

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“…6 Similarly, a retrospective review by Vogel and colleagues of data from 100 adults and children undergoing primary and secondary ETVs for a variety of etiologies reported delayed failure requiring surgery up to 16 years after these ETVs. 12 The 3 patients in our cohort who developed delayed failure (≥ 5 years) had all undergone secondary ETVs. They also presented with similar clinical symptoms including headaches and unsteadiness.…”

Section: Long-term Failuresmentioning

confidence: 99%

Long-term follow-up of endoscopic third ventriculostomy performed in the pediatric population

Stovell¹,

Zakaria

Ellenbogen

et al. 2016

PED

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OBJECTIVE Endoscopic third ventriculostomy (ETV) is an effective treatment for obstructive hydrocephalus and avoids the risk for foreign-body infection associated with ventriculoperitoneal (VP) shunts. The short-term failure rate of ETV strongly depends on the indications for its use but is generally thought to be lower in the long term than that of VP shunts. However, few studies are available with long-term follow-up data of ETV for hydrocephalus in children. The authors reviewed the long-term success of ETV at their institution to investigate the rate of any late failures of this procedure. METHODS Between April 1998 and June 2006, 113 children (including neonates and children up to 16 years old) had primary or secondary ETV for different causes of hydrocephalus. The patients' medical records and the authors' electronic operation database were reviewed for evidence of additional surgery (i.e., repeat ETV or VP shunt insertion). These records were checked at both the pediatric and adult neurosurgical hospitals for those patients who had their care transferred to adult services. RESULTS The median length of follow-up was 8.25 years (range 1 month to 16 years). Long-term follow-up data for 96 patients were available, 47 (49%) of whom had additional ETV or VP shunt insertion for ETV failure. Twenty patients (21%) had a second procedure within 1 month, 17 patients (18%) between 1 and 12 months, 7 patients (7%) between 1 and 5 years, and 3 patients (3%) between 5 and 8 years. CONCLUSIONS In the authors' series, ETV had an initial early failure rate for the treatment of pediatric hydrocephalus as reported previously, and this rate significantly depended on patient age and hydrocephalus etiology. Once stabilized and effective, ETV appeared to be durable but not guaranteed, and some late decline in effectiveness was observed, with some ETV failures occurring many years later. Thus, successful ETV in children cannot be guaranteed for life, and some form of follow-up is recommended long term into adulthood.

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The role of endoscopic third ventriculostomy in the treatment of hydrocephalus

Cited by 67 publications

References 33 publications

Endoscopic third ventriculostomy in children: prospective, multicenter results from the Hydrocephalus Clinical Research Network

Endoscopic third ventriculostomy in children: prospective, multicenter results from the Hydrocephalus Clinical Research Network

Comparison of Intracranial Neuroendoscopic Procedures in Children versus Adults

Long-term follow-up of endoscopic third ventriculostomy performed in the pediatric population

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