Third ventriculostomy vs ventriculoperitoneal shunt in pediatric obstructive hydrocephalus: results from a Swiss series and literature review

Ribaupierre, Sandrine de; Rilliet, Bénédict; Vernet, Olivier; Regli, Luca; Villemure, J.-G.

doi:10.1007/s00381-006-0283-4

Cited by 95 publications

(49 citation statements)

References 44 publications

(37 reference statements)

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“…[1][2][3] A number of studies worldwide have reported favorable outcomes; 4-6 however, in some cases, ETV fails to resolve symptoms, even when it is technically successful with adequate patent stoma and fenestrated Lillequist membrane. [7][8][9][10][11] It has been hypothesized that patients might suffer from hydrocephalus caused by other obstructive membranes or by fibrosis in the subarachnoid space, especially around basal cisterns.…”

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confidence: 99%

Cine Phase-Contrast MR Images Failed to Predict Clinical Outcome Following ETV

Xiao

Ragab

Luciano

2009

Can. j. neurol. sci.

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Endoscopic third ventriculostomy (ETV) has been a popular surgical option for obstructive hydrocephalus (OHCP) in recent decades. [1][2][3] A number of studies worldwide have reported favorable outcomes; 4-6 however, in some cases, ETV fails to resolve symptoms, even when it is technically successful with adequate patent stoma and fenestrated Lillequist membrane. [7][8][9][10][11] It has been hypothesized that patients might suffer from hydrocephalus caused by other obstructive membranes or by fibrosis in the subarachnoid space, especially around basal cisterns. Cine phase-contrast magnetic resonance imaging (PC MR) has been utilized as a method of distinguishing between ABSTRACT: Background: To predict success of endoscopic third ventriculostomy (ETV) in patients with obstructive hydrocephalus, we evaluated pre-and post-operative phase-contrast cine magnetic resonance images (PC MRI) on cerebrospinal fluid (CSF), cine flow in basal cisterns around the brain stem, and cervical medullar junction (CMJ) retrospectively. Methods: The study involved 102 patients with mean age of 36.74±23.25, and F/M = 1.55. All patients had PC MRI taken both pre-and post-operatively. A dynamic MRI video of PC MRI was reviewed at sagittal, axial, and coronal sections to determine cistern flows around the brain stem and CMJ. For quantitative analysis, quadrants were divided around midbrain axially to evaluate interpeduncular, quadrageminal, and ambient cisterns of both sides using scores of 0 to 60. Pre-and post-pontine and CMJ flows were shown in sagittal view and scored 0 to 20, and lateral cerebellopontine cisterns of both sides were measured on coronal image and scored 0 to 20. Results: No significant difference in CSF flow was seen from three individual views and total cine score, or between ETV success and failure groups by multivariate analysis of variance. Kaplan-Meier Analysis and Spearman's Correlation Test produced no relationship between MRI cine flow scores and interval period after surgery to ETV failure. Conclusion: PC MRI cine flow failed to demonstrate significant differences between successful and failed ETV groups. This indicates in addition to achieving an adequate fenestration, CSF pathways beyond the basal cisterns around the brain stem and CMJ may play an essential role in achieving ETV success. Aucune différence significative du flux du LCR n'a été observée sur trois clichés individuels et l'analyse de variance multivariée n'a décelé aucune différence significative du score ciné total ou entre les groupes dont la VET a été un succès ou un échec. Le test de Kaplan-Meier et le test de corrélation de Spearman n'ont pas montré de relation entre les scores du flux au ciné IRM et l'intervalle entre la chirurgie ou entre les scores et l'échec de la VET. Conclusion : Le ciné IRM CP du flux n'a pas montré de différence significative entre le groupe dont la VET a été un succès et le groupe dont la VET a été un échec. Ceci indique qu'en plus de réussir à établir une fenestration adéquate, les voies du LCR au-delà des citer...

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mentioning

confidence: 99%

Cine Phase-Contrast MR Images Failed to Predict Clinical Outcome Following ETV

Xiao

Ragab

Luciano

2009

Can. j. neurol. sci.

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“…Besides the surgical letality (approx-Open Journal of Modern Neurosurgery imately 8%), the mortality rate over 20 years of follow-up has been reduced from 39% in the 1960s to 21% in the 1980s for patients without a tumor as underlying disease [50] [51]. Many patients present with neurologic deficits such as motor, visual or auditory impairment, and a huge number of deaths is due to delayed diagnosis of CSF diversion malfunction, regardless whether a shunt implantation or an endoscopic fenestration have been performed [11] [43]. The neurologic and intellectual development depends largely on the etiology of the hydrocephalus and the intercurrent diseases such as intracranial hemorrhage, ventriculitis or accompanying epileptic seizures.…”

Section: Long-term Resultsmentioning

confidence: 99%

Surgical Treatment for Neonatal Hydrocephalus: Catheter-Based Cerebrospinal Fluid Diversion or Endoscopic Intervention?

Krause¹,

Panteliadis²,

Hagel³

et al. 2018

OJMN

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Neonatal hydrocephalus can arise from a multitude of disturbances, among them congenital aqueductal stenosis, myelomeningocele or posthemorrhagic complications in preterm infants. Diagnostic work-up comprises transfontanellar ultrasonography, T2 weighted MRI and clinical assessment for rare inherited syndromes. Classification of hydrocephalus and treatment guidelines is based on detailed consensus statements. The recent evidence favors catheter-based cerebrospinal fluid diversion in children below 6 months, but emerging techniques such as neuroendoscopic lavage carry the potential to lower shunt insertion rates. More long-term study results will be needed to allow for individualized, multidisciplinary decision making. This article gives an overview regarding contemporary pathophysiological concepts, the latest consensus statements and most recent technical developments. KeywordsCerebrospinal Fluid, Hydrocephalus, Neonate, Neuroendoscopy, VP-Shunt The Cerebrospinal Fluid SystemThe cerebrospinal fluid (CSF) system provides mechanical protection of the brain against mild trauma, is involved in nutrient supply and waste removal, and plays a role in the circadian rhythm [1]. In humans it comprises 4 cavities in the brain, the ventricles, which normally take up about 20% of the CSF. In addition, How to cite this paper: Krause, M., Panteliadis, C.P., Hagel, C., Hirsch, F.W., Thome HydrocephalusHydrocephalus is a disbalance between CSF production and resorption. Clinical PresentationMost children with hydrocephalus suffer from a chronic disease with a rather slow progress of symptoms. Only 10% -15% of newborns with hydrocephalus show signs of elevated intracranial pressure [11].In preterm infants, hydrocephalic growth of the neurocranium is preceded by an ultrasonographically detectable enlargement of the ventricles. At this time, the endochondral bone formation of the skull fragments still allows for a certain flexibility and the small children often suffer from a multitude of additional regulatory deficits owing to their immaturity. Therefore the signs of increased intracranial pressure such as bradycardia or respiratory insufficiency are less obvious than in older children. In newborns or infants under the age of 2, the crossing of percentiles of the head circumference compared to body height and weight is the most important sign of isolated hydrocephalus [11].Typical concurring symptoms are a tight, bulging anterior fontanel, dehiscence of skull sutures, increased visibility of scalp veins and a huge frontal bone (frontal bossing). Retraction of the upper eye-lids, together with Parinaud's upgaze palsy can lead to the rare, but very impressive sunset phenomenon, with both irises plunging half below the lower eye-lids.A number of hereditary syndromes, which mostly follow a recessive inheritance, are associated with hydrocephalus (Table 2). Thus, pediatric patients suffering from hydrocephalus of unknown etiology should be examined thoroughly for stigmata indicating an inherited disease.In older children acu...

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“…In the same study, shunt independence after ETV was achieved in 82% of patients with tumor-related obstructive hydrocephalus. In a Swiss series by de Ribaupierre et al 6 with 48 pediatric patients (0-18 years old), 24 had preoperative ETV because of obstructive hydrocephalus. Of these, 8 patients experienced failure of the ETV, of whom 5 eventually needed a VP shunt.…”

Section: Preoperative Hydrocephalus and Its Treatmentmentioning

confidence: 99%

Cerebrospinal fluid disturbances after 381 consecutive craniotomies for intracranial tumors in pediatric patients

Hosainey

Lassen

Helseth

et al. 2014

PED

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Object The aim of this study was to investigate the incidence of CSF disturbances before and after intracranial surgery for pediatric brain tumors in a large, contemporary, single-institution consecutive series. Methods All pediatric patients (those < 18 years old), from a well-defined population of 3.0 million inhabitants, who underwent craniotomies for intracranial tumors at Oslo University Hospital in Rikshospitalet between 2000 and 2010 were included. The patients were identified from the authors' prospectively collected database. A thorough review of all medical charts was performed to validate all the database data. Results Included in the study were 381 consecutive craniotomies, performed on 302 patients (50.1% male, 49.9% female). The mean age of the patients in the study was 8.63 years (range 0–17.98 years). The follow-up rate was 100%. Primary craniotomies were performed in 282 cases (74%), while 99 cases (26%) were secondary craniotomies. Tumors were located supratentorially in 249 cases (65.3%), in the posterior fossa in 105 (27.6%), and in the brainstem/diencephalon in 27 (7.1%). The surgical approach was supratentorial in 260 cases (68.2%) and infratentorial in 121 (31.8%). Preoperative hydrocephalus was found in 124 cases (32.5%), and 71 (86.6%) of 82 achieved complete cure with tumor resection only. New-onset postoperative hydrocephalus was observed in 9 (3.5%) of 257 cases. The rate of postoperative CSF leaks was 6.3%. Conclusions Preoperative hydrocephalus was found in 32.5% of pediatric patients with brain tumors treated using craniotomies. Tumor resection alone cured preoperative hydrocephalus in 86.6% of cases and the incidence of new-onset hydrocephalus after craniotomy was only 3.5%.

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Third ventriculostomy vs ventriculoperitoneal shunt in pediatric obstructive hydrocephalus: results from a Swiss series and literature review

Cited by 95 publications

References 44 publications

Cine Phase-Contrast MR Images Failed to Predict Clinical Outcome Following ETV

Cine Phase-Contrast MR Images Failed to Predict Clinical Outcome Following ETV

Surgical Treatment for Neonatal Hydrocephalus: Catheter-Based Cerebrospinal Fluid Diversion or Endoscopic Intervention?

Cerebrospinal fluid disturbances after 381 consecutive craniotomies for intracranial tumors in pediatric patients

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