Third Ventriculocisternostomy for Shunt Failure

Chhun, Virakpagna; Sacko, Oumar; Boetto, S.; Roux, Franck‐Emmanuel

doi:10.1016/j.wneu.2015.01.058

Cited by 23 publications

(13 citation statements)

References 44 publications

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“…However, there is also an increasing experience with using ETV to treat patients presenting with shunt failure when there is an underlying diagnosis of obstructive hydrocephalus. 2,4,11 In this article we describe a population of 163 symptomatic adult patients with hydrocephalus who underwent ETV-112 patients treated primarily and 51 patients treated when they presented with VP shunt malfunction (secondary ETV); the mean and median clinical follow-up duration was approximately 8 years. We also report the results associated with repeating ETVs in patients in whom the initial response was suboptimal or successful but subsequently failed.…”

Section: Discussionmentioning

confidence: 99%

“…14,15 There is now an abundance of literature on the long-term outcomes of ETV in the pediatric population, and some case-series have reported mixed pediatric and adult data. 4,8,19 Nevertheless, large population studies that have focused on the role of ETV in only adult hydrocephalus are comparatively lacking except for a few studies, which have only reported limited follow-up durations. 23,26,31,36 The objective of this article is to evaluate the long-term efficacy of ETV in the management of adult hydrocephalus in a large single-center population.…”

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confidence: 99%

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Endoscopic third ventriculostomy for treatment of adult hydrocephalus: long-term follow-up of 163 patients

Isaacs¹,

Bezchlibnyk²,

Yong

et al. 2016

FOC

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OBJECTIVE The efficacy of endoscopic third ventriculostomy (ETV) for the treatment of pediatric hydrocephalus has been extensively reported in the literature. However, ETV-related long-term outcome data are lacking for the adult hydrocephalus population. The objective of the present study was to assess the role of ETV as a primary or secondary treatment for hydrocephalus in adults. METHODS The authors performed a retrospective chart review of all adult patients (age ≥ 18 years) with symptomatic hydrocephalus treated with ETV in Calgary, Canada, over a span of 20 years (1994–2014). Patients were dichotomized into a primary or secondary ETV cohort based on whether ETV was the initial treatment modality for the hydrocephalus or if other CSF diversion procedures had been previously attempted respectively. Primary outcomes were subjective patient-reported clinical improvement within 12 weeks of surgery and the need for any CSF diversion procedures after the initial ETV during the span of the study. Categorical and actuarial data analysis was done to compare the outcomes of the primary versus secondary ETV cohorts. RESULTS A total of 163 adult patients with symptomatic hydrocephalus treated with ETV were identified and followed over an average of 98.6 months (range 0.1–230.4 months). All patients presented with signs of intracranial hypertension or other neurological symptoms. The primary ETV group consisted of 112 patients, and the secondary ETV consisted of 51 patients who presented with failed ventriculoperitoneal (VP) shunts. After the initial ETV procedure, clinical improvement was reported more frequently by patients in the primary cohort (87%) relative to those in the secondary ETV cohort (65%, p = 0.001). Additionally, patients in the primary ETV group required fewer reoperations (p < 0.001), with cumulative ETV survival time favoring this primary ETV cohort over the course of the follow-up period (p < 0.001). Fifteen patients required repeat ETV, with all but one experiencing successful relief of symptoms. Patients in the secondary ETV cohort also had a higher incidence of complications, with one occurring in 8 patients (16%) compared with 2 in the primary ETV group (2%; p = 0.010), although most complications were minor. CONCLUSIONS ETV is an effective long-term treatment for selected adult patients with hydrocephalus. The overall ETV success rate when it was the primary treatment modality for adult hydrocephalus was approximately 87%, and 99% of patients experience symptomatic improvement after 2 ETVs. Patients in whom VP shunt surgery fails prior to an ETV have a 22% relative risk of ETV failure and an almost eightfold complication rate, although mostly minor, when compared with patients who undergo a primary ETV. Most ETV failures occur within the first 7 months of surgery in patients treated with primary ETV, but the time to failure is more prolonged in patients who present with failed previous shunts.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Endoscopic third ventriculostomy for treatment of adult hydrocephalus: long-term follow-up of 163 patients

Isaacs¹,

Bezchlibnyk²,

Yong

et al. 2016

FOC

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“…11 As a result, ETV was proposed to be the firstline therapeutic option for the treatment of a blocked shunt in cases of initial obstructive hydrocephalus. 4,5 In this case, these patients could have an opportunity of becoming shunt independent. 25 At the same time, ETV has been shown to be effective in treating cases of communicating hydrocephalus.…”

Section: Discussionmentioning

confidence: 96%

Emergency endoscopic third ventriculostomy for blocked shunts? Univariate and multivariate analysis of independent predictors for failure

Chan¹,

Tsang²,

Ho³

et al. 2019

Journal of Neurosurgery

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OBJECTIVEHydrocephalus with a blocked ventriculoperitoneal (VP) shunt is a life-threatening condition. Emergency endoscopic third ventriculostomy (ETV) is a potential treatment option. The aim of the study was to identify independent risk factors associated with failure of ETV in treating patients with blocked shunts.METHODSThe authors retrospectively reviewed data from consecutive patients admitted for blocked shunt treated by ETV during the study period from 2000 to 2016. Univariate and multivariate analyses were performed to identify independent factors associated with failed ETV for blocked shunts, such as age, sex, history of CNS infection, number of previous shunt revisions, operations performed as an emergency or elective, number of specialists, and other factors.RESULTSIn total, 121 patients underwent ETV during the study period. Of these, 31 patients (25.6%) had ETV for treatment of a blocked shunt. In 25 (80.6%) of 31 ETV was performed as an emergency procedure. There was no significant difference in the success rate of ETV depending on whether it was performed as an emergency procedure (64% [16/25]) or an elective procedure (66.7% [4/6]; OR 0.062, 95% CI 0.001–2.708; p = 0.149). Univariate and multivariate analyses identified that history of a CNS infection was an independent risk factor for failure of ETV in treating patients with a blocked shunt (OR 0.030, 95% CI 0.001–0.888; p = 0.043).CONCLUSIONSEmergency ETV had a comparable success rate as elective ETV. A history of CNS infection is an independent predictor of ETV failure in treating patients with blocked shunts.

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“…In fact it is now accepted as a therapeutic option ahead of shunt revision in cases of obstructive hydrocephalus. [24]…”

Section: Complicationsmentioning

confidence: 99%

Anesthesia for endoscopic third ventriculostomy in children

Rajesh

2017

Anesth Essays Res

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Third Ventriculocisternostomy for Shunt Failure

Cited by 23 publications

References 44 publications

Endoscopic third ventriculostomy for treatment of adult hydrocephalus: long-term follow-up of 163 patients

Endoscopic third ventriculostomy for treatment of adult hydrocephalus: long-term follow-up of 163 patients

Emergency endoscopic third ventriculostomy for blocked shunts? Univariate and multivariate analysis of independent predictors for failure

Anesthesia for endoscopic third ventriculostomy in children

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