Long-term outcome and neurologic development after endoscopic third ventriculostomy versus shunting during infancy

2006 ◽  
Vol 22 (12) ◽  
pp. 1591-1602 ◽  
Author(s):  
Yoshio Takahashi
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Third Ventriculostomy ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Neurologic Development

Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus: validation of a success score that predicts long-term outcome

2011 ◽  
Vol 8 (5) ◽  
pp. 489-493 ◽  
Author(s):  
Andrew J. Durnford ◽  
Fenella J. Kirkham ◽  
Nijaguna Mathad ◽  
Owen C. E. Sparrow
Keyword(s):  
Clinical Decision Making ◽  
Endoscopic Third Ventriculostomy ◽  
Risk Groups ◽  
Individual Characteristics ◽  
Third Ventriculostomy ◽  
Success Rates ◽  
Term Outcome ◽  
Long Term Outcome ◽  
High Chance

Object The goal of this study was to externally validate the proposed Endoscopic Third Ventriculostomy Success Score (ETVSS), which predicts successful treatment for hydrocephalus on the basis of a child's individual characteristics. Methods The authors retrospectively identified 181 cases of consecutive endoscopic third ventriculostomy (ETV) performed in children at a single neurosurgery center in the United Kingdom. They compared actual success at both 6 and 36 months, with mean predicted probabilities for low, moderate, and high chance of success strata based on the ETVSS. Long-term success was calculated using Kaplan-Meier methods and comparisons were made by means of unpaired t-tests. Results Overall, 166 primary ETVs were performed; ETV success was 72.9% at 6 and 64.5% at 36 months. At long-term follow-up, the mean predicted probability of success was significantly higher in those with a successful ETV (99 patients) than in those with a failed ETV (67 patients) (p = 0.001). The ETVSS accurately predicted outcome at 36 months; the low, medium, and high chance of success strata had mean predicted probabilities of success of 82%, 63%, and 36%, and actual success of 76%, 66%, and 42%, respectively. The overall complication rate was 6%. Conclusions The ETVSS closely predicted the overall long-term success rates in high-, moderate-, and low-risk groups. The results of this study suggest that the ETVSS will aid clinical decision making in predicting outcome of ETV.

Long-Term Outcome of Endoscopic Third Ventriculostomy in Obstructive Hydrocephalus

2007 ◽  
Vol 50 (5) ◽  
pp. 265-269 ◽  
Author(s):  
M. Gangemi ◽  
C. Mascari ◽  
F. Maiuri ◽  
U. Godano ◽  
P. Donati ◽  
...  
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
Third Ventriculostomy ◽  
Term Outcome ◽  
Long Term Outcome

scholarly journals Endoscopic third ventriculostomy in adult patients

2005 ◽  
Vol 19 (6) ◽  
pp. 1-6 ◽  
Author(s):  
Amin Amini ◽  
Richard H. Schmidt
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Surgical Techniques ◽  
Adult Patients ◽  
Doppler Imaging ◽  
Third Ventriculostomy ◽  
Term Outcome ◽  
Long Term Outcome

Endoscopic third ventriculostomy (ETV) has gained popularity and has become the treatment of choice for certain pediatric and adult hydrocephalic conditions. The authors report their experience with 36 adult patients and evaluate the long-term outcome and safety of ETV. They discuss several improvements to the surgical techniques that they have developed based on their experience, including the use of intraoperative Doppler imaging before fenestration to trace the location of vessels underlying the floor of the third ventricle. They also report the use of a Rickham reservoir and endoventricular stent in selected cases and discuss the indications for their use. In cases of obstructive hydrocephalus due to congenital or acquired aqueductal stenosis in adults, the success rate of ETV in avoidance of shunt placement is 72%. Twenty-two percent of the patients in this series in whom ETV was initially successful later experienced closure of the fenestration and recurrent symptoms at a mean interval of 3.75 years. Thus, in patients who undergo this treatment, long-term periodic follow-up review should be performed.

scholarly journals Hydrocephalus treatment in children: long-term outcome in 975 consecutive patients

2017 ◽  
Vol 20 (1) ◽  
pp. 10-18 ◽  
Author(s):  
Pierre-Aurelien Beuriat ◽  
Stephanie Puget ◽  
Giuseppe Cinalli ◽  
Thomas Blauwblomme ◽  
Kevin Beccaria ◽  
...  
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Differential Pressure ◽  
Third Ventriculostomy ◽  
Term Outcome ◽  
Shunt Insertion ◽  
Long Term Outcome ◽  
Common Cause ◽  
Ventriculoperitoneal Shunting ◽  
Shunt Survival

OBJECTIVEHydrocephalus remains one of the more common pathologies managed in pediatric neurosurgical units. Endoscopic third ventriculostomy (ETV) has an advantage over ventriculoperitoneal shunting as it enables patients to remain device free. Multiple shunt devices with various valve designs exist, with no one valve proven to be superior to another. The aim of this study was to describe the management of hydrocephalus and its long-term outcome.METHODSThe authors retrospectively reviewed the medical records of all patients who had been treated for hydrocephalus at the Hôpital Necker-Enfants Malades in the period from 1985 to 1995.RESULTSNine hundred seventy-five children had been treated for hydrocephalus. The mean follow-up was 11 ± 7.4 years (mean ± standard deviation). The most common cause of hydrocephalus was tumor related (32.3%), followed by malformative (24.5%) and inflammatory (20.9%) causes. Two hundred eighty patients underwent ETV as the first-line treatment. The procedure was effective in controlling hydrocephalus due to posterior fossa tumors and aqueductal stenosis. Six hundred ninety-five children had initial shunt insertion, with the majority receiving an Orbis-Sigma valve (OSV). The overall OSV shunt survival was 70% at 1 year, 58% at 10 years, and 49% at 20 years. The most common cause for mechanical shunt failure was obstruction (50.7%). Overall shunt survival was statistically different between the OSV and the differential-pressure valve (p = 0.009).CONCLUSIONSEndoscopic third ventriculostomy is effective in the management of childhood hydrocephalus. Its success is directly related to the underlying pathology. In the long term, the OSV has significantly higher event-free shunt survival than the classic differential-pressure valve systems

Endoscopic third ventriculostomy for myelomeningocele-related hydrocephalus after shunt failure: Long-term outcome in a series of 8 patients

2021 ◽  
Vol 201 ◽  
pp. 106406
Author(s):  
Nobuyuki Takeshige ◽  
Hisaaki Uchikado ◽  
Daisuke Nakashima ◽  
Tetsuya Negoto ◽  
Satoshi Nagase ◽  
...  
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Third Ventriculostomy ◽  
Shunt Failure ◽  
Term Outcome ◽  
Long Term Outcome

scholarly journals Endoscopic third ventriculostomy for hydrocephalus: a study of thirty cases

2019 ◽  
Vol 6 (4) ◽  
pp. 1120
Author(s):  
Paresh Sodhiya ◽  
Zafar Ahmed Sheikh ◽  
Mukesh Sharma ◽  
Meen Morey
Keyword(s):  
Success Rate ◽  
Age Groups ◽  
Third Ventriculostomy ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Abnormal Accumulation ◽  
Threatening Condition ◽  
Life Threatening ◽  
Surgical Modality

Background: Raised intracranial pressure because of abnormal accumulation of CSF with in the ventricles of brain is a potentially life-threatening condition. Ventriculoperitoneal shunt remains mainstay of treatment even today. However, shunt failure is not uncommon. Hence endoscopic procedures are now gaining popularity. The outcome of ETV with respect to age ,etiology and long-term outcome needs further elucidation.Methods: Thirty patients with hydrocephalus who underwent endoscopic treatment were analysed retrospectively with respect to age, diagnosis, surgical outcome, treatment failure and complications.Results: Total of 28 patients successfully underwent ETV and with an overall success rate of 78%. Moreover, the success rate of ETV was found to be 100% in the 0-1 and 80% in 1-2 years age groups. 2 patients required re operation in the form of VP shunt.Conclusions: ETV is a safe and effective surgical modality with comparable outcome in paediatric and adult populations. 

Five-year survival and outcome of treatment for postinfectious hydrocephalus in Ugandan infants

2011 ◽  
Vol 8 (5) ◽  
pp. 502-508 ◽  
Author(s):  
Benjamin C. Warf ◽  
Ariella R. Dagi ◽  
Brian Nsubuga Kaaya ◽  
Steven J. Schiff
Keyword(s):  
Statistical Significance ◽  
Neonatal Infection ◽  
Treated Group ◽  
Primary Treatment ◽  
Third Ventriculostomy ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Shunt Placement ◽  
Kaplan Meier

Object Neonatal infection is the most common cause of infant hydrocephalus in Uganda. Postinfectious hydrocephalus (PIH) is often accompanied by primary brain injury from the original infection. Since 2001, ETV (with or without choroid plexus cauterization) has been our primary treatment for PIH. The long-term outcome in these children is unknown. Methods We studied the 5-year outcome in a cohort of 149 infants treated for PIH from 2001 to 2005 and who lived in 4 districts close to the hospital. Survival analysis was performed using the Kaplan-Meier method. Statistical significance was determined using the Fisher, Breslow, and log-rank tests. Results The patients' mean age at presentation was 9.5 months (median 3.0 months). Eighty-four patients (56.4%) were successfully treated without a shunt. Operative mortality was 1.2% for ETV and 4.4% for shunt placement (p = 0.3). Five-year survival was 72.8% in the non–shunt-treated group and 67.6% in the shunt-treated group, with no difference in survival (log rank p = 0.43, Breslow p = 0.46). Of 43 survivors assessed at 5–11 years, those with shunts had significantly worse functional outcomes (p = 0.003–0.035), probably reflecting treatment selection bias since those with the worst sequelae of ventriculitis were more likely to be treated with shunt placement. Conclusions Nearly one-third of treated infants died within 5 years, and at least one-third of the survivors were severely disabled. There was no survival advantage for non–shunt-treated patients at 5 years. A randomized trial of endoscopic third ventriculostomy versus shunt placement for treating PIH may be indicated. Public health measures that prevent these infections are urgently needed.

Long-term outcome for endoscopic third ventriculostomy alone or in combination with choroid plexus cauterization for congenital aqueductal stenosis in African infants

2012 ◽  
Vol 10 (2) ◽  
pp. 108-111 ◽  
Author(s):  
Benjamin C. Warf ◽  
Sarah Tracy ◽  
John Mugamba
Keyword(s):  
Treatment Failure ◽  
Choroid Plexus ◽  
Endoscopic Third Ventriculostomy ◽  
Aqueductal Stenosis ◽  
Wilcoxon Test ◽  
Rank Test ◽  
Third Ventriculostomy ◽  
Long Term Outcome ◽  
Choroid Plexus Cauterization

Object The authors have previously reported on the overall improved efficacy of endoscopic third ventriculostomy (ETV) combined with choroid plexus cauterization (CPC) for infants younger than 1 year of age. In the present study they specifically examined the long-term efficacy of ETV with or without CPC in 35 infants with congenital aqueduct stenosis treated at CURE Children's Hospital of Uganda during the years 2001–2006. Methods Infants with congenital aqueductal stenosis were treated during 2 distinct treatment epochs: all underwent ETV alone, and subsequently all underwent ETV-CPC. Prospectively collected data in the clinical database were reviewed for all infants with an age < 1 year who had been treated for hydrocephalus due to congenital aqueductal stenosis. Study exclusion criteria included: 1) a history or findings on imaging or at the time of ventriculoscopy that suggested a possible infectious cause of the hydrocephalus, including scarred choroid plexus; 2) an open aqueduct or an aqueduct obstructed by a membrane or cyst rather than by stenosis; 3) severe malformations of the cerebral hemispheres including hydranencephaly, significant segments of undeveloped brain, or schizencephaly; 4) myelomeningocele, encephalocele, Dandy-Walker complex, or tumor; or 5) previous shunt insertion. The time to treatment failure was analyzed using the Kaplan-Meier method to construct survival curves. Log-rank (Mantel-Cox) and Gehan-Breslow-Wilcoxon tests were used to determine whether differences between the 2 treatment groups were significant. Results Thirty-five patients met the study criteria. Endoscopic third ventriculostomy alone was performed in 12 patients (mean age 4.7 months), and combined ETV-CPC was performed in 23 patients (mean age 3.5 months). For patients without treatment failure, the mean and median follow-ups were, respectively, 51.6 and 48.0 months in the ETV group and 31.2 and 26.4 months in the ETV-CPC group. Treatment was successful in 48.6% of the patients who underwent ETV alone, as accurately predicted by the Endoscopic Third Ventriculostomy Success Score (ETVSS), and in 81.9% of the patients who underwent ETV-CPC (p = 0.0119, log-rank test; p = 0.0041, Gehan-Breslow-Wilcoxon test; HR 6.42 [95% CI 1.51–27.36]). Conclusions Combined ETV-CPC is significantly superior to ETV alone for infants younger than 1 year of age with congenital aqueductal stenosis. The fact that the outcome for ETV alone was accurately predicted by the ETVSS suggests that these results are applicable in developed countries.

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