Quality of life in obstructive hydrocephalus: endoscopic third ventriculostomy compared to cerebrospinal fluid shunt

Object Quality of life (QOL) studies comparing treatment with endoscopic third ventriculostomy (ETV) and CSF shunting are very limited. The authors compared QOL outcomes following these 2 treatments in a large cohort of children with hydrocephalus by using multivariable statistical techniques to adjust for possible confounder variables. Methods The families of children between 5 and 18 years of age with previously treated hydrocephalus at 3 Canadian pediatric neurosurgery centers completed measures of QOL: the Hydrocephalus Outcome Questionnaire (HOQ) and the Health Utilities Index Mark 3 (HUI3). Medical records and recent brain imaging studies were reviewed. A linear regression analysis was performed with the QOL measures as the dependent variable. In multivariable analyses, the authors assessed the independent effect of initial hydrocephalus treatment (ETV vs shunting) while adjusting for the treatment center, current patient age, age at initial treatment, etiology of hydrocephalus, total number of days spent in the hospital for initial treatment, total number of days spent in the hospital for subsequent hydrocephalus complications, functioning ETV at follow-up assessment, frequency of seizures, and current ventricle size. Results Data from 603 patients were available for analysis. Fifty-eight patients had undergone ETV as their primary treatment and 545 had undergone CSF shunting. Endoscopic third ventriculostomy patients were slightly younger at the follow-up assessment, were older at the first surgery, and spent fewer days in the hospital for hydrocephalus complications. Without adjustment for any confounders, treatment with ETV was associated with significantly higher HOQ physical scores and HUI3 scores. After multivariable adjustment, however, there was no significant difference in any outcome measure. A functioning ETV at the time of the follow-up assessment was not significant in any model. Conclusions Treatment with either ETV or CSF shunting does not appear to be associated with any substantial difference in QOL outcome after adjusting for prognostic factors. Further study is needed to definitively determine the relative QOL benefit of either procedure, if any.

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Role of endoscopic third ventriculostomy at infected cerebrospinal fluid shunt removal

Journal of Neurosurgery Pediatrics ◽

10.3171/2011.12.peds11229 ◽

2012 ◽

Vol 9 (3) ◽

pp. 320-326 ◽

Cited By ~ 18

Author(s):

Tomohisa Shimizu ◽

Mark G. Luciano ◽

Toru Fukuhara

Keyword(s):

Risk Factors ◽

Cerebrospinal Fluid ◽

Endoscopic Third Ventriculostomy ◽

Shunt Infection ◽

Secondary Outcome ◽

Csf Shunt ◽

Third Ventriculostomy ◽

Cerebrospinal Fluid Shunt ◽

Csf Shunts ◽

Shunt Removal

Object Cerebrospinal fluid shunt infection is distressing, especially in the pediatric population. Usually, infected CSF shunts are removed, and after temporary external CSF drainage, reinsertion of the CSF shunt is necessary. Unfortunately, it is not rare to encounter CSF reinfection after shunt renewal, and furthermore, the reinserted CSF shunt is at a considerable risk of malfunction. Endoscopic third ventriculostomy (ETV) is a potent option in managing CSF shunt infection, although ETV failure may occur more frequently when it is used to remove an infected shunt. The authors retrospectively evaluated CSF reinfection after using ETV during removal of infected CSF shunts; then the longevity of ETV and of successive reinserted ventriculoperitoneal shunts (VPSs) after ETV failure were also examined. Methods Children with shunted hydrocephalus were retrospectively reviewed, and data on their initial CSF shunt infections were extracted. Thirty-six children underwent VPS reinsertion (the VPS group), and 9 underwent ETV after removal of the infected CSF shunt (the ETV group). As the primary outcome, ETV efficacy against CSF reinfection within 6 months was analyzed by comparing the reinfection rates, and the risk factors for CSF reinfection were analyzed by logistic regression. The longevity of the reinserted shunt in the VPS group was calculated using the Kaplan-Meier method, which was compared with ETV longevity as the secondary outcome, and also with the longevity of reinserted VPSs in the ETV group after ETV failure as the tertiary outcome. Results Reinfection of CSF was seen in 27.8% of children in the VPS group. Among 9 children in the ETV group, only 1 (11.1%) had CSF reinfection. However, logistic regression analysis failed to show that performing ETV was a significant factor protecting against CSF reinfection: the significant risk factors were younger age at reinsertion of VPS or ETV (p = 0.037) and a history of shunt revisions (p = 0.011). The longevity of reinserted VPSs in the VPS group was calculated to be 658 ± 166.3 days (mean ± SE). Longevity of ETV was compared in the analysis of the secondary outcome, which was 929.2 ± 511.1 days, and there were no significant differences between these durations. Only 2 ETVs stayed patent, and a VPS was eventually implanted in the other 7 children. The longevity of this reinserted VPS in the ETV group, calculated based on these 7 children, was 2011.1 ± 540.7 days, which was confirmed to be longer than that in the VPS group (p = 0.031). Conclusions Although the protective effect of using ETV during removal of an infected CSF shunt on reinfection is marginal, the ETV longevity can be considered equivalent to that of reinserted VPSs. Even if ETV failure occurs, the reinserted VPS has significantly better longevity than a VPS reinserted without using ETV, and use of ETV during infected CSF shunt removal can be considered a potent alternative or at least an adjunct to VPS reinsertion.

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Failure to treat obstructive hydrocephalus with endoscopic third ventriculostomy in a patient with neurodegenerative Langerhans cell histiocytosis

Journal of Neurosurgery Pediatrics ◽

10.3171/ped.2008.2.11.304 ◽

2008 ◽

Vol 2 (5) ◽

pp. 304-309 ◽

Cited By ~ 5

Author(s):

Amir Kershenovich ◽

Angela V. Price ◽

Korgun Koral ◽

Stan Goldman ◽

Dale M. Swift

Keyword(s):

Central Nervous System ◽

Cerebrospinal Fluid ◽

Nervous System ◽

Langerhans Cell Histiocytosis ◽

Endoscopic Third Ventriculostomy ◽

Obstructive Hydrocephalus ◽

Central Nervous System Involvement ◽

Magnetic Resonance Images ◽

Third Ventriculostomy ◽

Biopsy Specimens

The second most frequent central nervous system involvement pattern in Langerhans cell histiocytosis (LCH) is a rare condition documented in a number of reports called “neurodegenerative LCH” (ND-LCH). Magnetic resonance images confirming the presence of the disease usually demonstrate striking symmetric bilateral hyperintensities predominantly in the cerebellum, basal ganglia, pons, and/or cerebral white matter. The authors here describe for the first time in the literature a patient with ND-LCH and concomitant hydrocephalus initially treated using endoscopic third ventriculostomy (ETV). This 9-year-old boy, who had undergone chemotherapy for skin and lung LCH without central nervous system involvement at the age of 10 months, presented with acute ataxia, headaches, and paraparesis and a 1-year history of gradually increasing clumsiness. Magnetic resonance images showed obstructive hydrocephalus at the level of the aqueduct of Sylvius and signs of ND-LCH. After registering high intracranial pressure (ICP) spikes with an intraparenchymal pressure monitor, an ETV was performed. A second ETV was required months later because of ostomy occlusion, and finally a ventriculoperitoneal shunt was placed because of ostomy reocclusion. Endoscopic third ventriculostomy was initially considered the treatment of choice to divert cerebrospinal fluid without leaving a ventriculoperitoneal shunt and to obtain biopsy specimens from the periinfundibular recess area. The third ventriculostomy occluded twice, and an endoscopic aqueduct fenestration was unsuccessful. The authors hypothesized that an inflammatory process related to late ND disease was responsible for the occlusions. Biopsy specimens from the infundibular recess and fornix column did not show histopathogical abnormalities. Increased ICP symptoms resolved with cerebrospinal fluid diversion. This case is the first instance of ND-LCH with hydrocephalus reported in the literature to date. Shunt placement rather than ETV seems to be the favorable choice in relieving elevated ICP.

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Quality of life in children with hydrocephalus treated with endoscopic third ventriculostomy

Journal of Neurosurgery Pediatrics ◽

10.3171/2020.8.peds20384 ◽

2021 ◽

pp. 1-8

Author(s):

Ángela Ros-Sanjuán ◽

Sara Iglesias-Moroño ◽

Bienvenido Ros-López ◽

Francisca Rius-Díaz ◽

Andrea Delgado-Babiano ◽

...

Keyword(s):

Quality Of Life ◽

Endoscopic Third Ventriculostomy ◽

Epileptic Seizures ◽

Third Ventriculostomy ◽

Neurosurgical Procedures ◽

Physical Domain ◽

History Of ◽

The Mean

OBJECTIVEThe objectives of this study were to determine the quality of life of a pediatric cohort with hydrocephalus treated by endoscopic third ventriculostomy (ETV), using the Hydrocephalus Outcome Questionnaire–Spanish version (HOQ-Sv), and study the clinical and radiological factors associated with a better or worse functional status.METHODSThis cross-sectional study was undertaken between September 2018 and December 2019. It comprised a series of 40 patients ranging from 5 to 18 years old with hydrocephalus treated by ETV. ETV was considered to be successful if there was no need for surgery for the treatment of hydrocephalus after a minimum follow-up of 6 months. The clinical variables included gender, age at hydrocephalus diagnosis, age at the time of ETV, age at completion of the questionnaire, etiology and type of hydrocephalus (communicating or not), prior shunt, repeat ETV, number of neurosurgical procedures, number of epileptic seizures, presenting signs, and follow-up duration until last office revision. The radiological variables were the Evans Index and the pre- and posttreatment frontooccipital horn ratio. An analysis was conducted of the association between all these variables and the various dimensions on the HOQ-Sv, completed by the parents of the patients via telephone or in the outpatient offices.RESULTSThe mean age of the children at ETV was 7 years (range 7–194 months), and on completing the questionnaire was 12 years (range 60–216 months). The mean HOQ scores were as follows: overall 0.82, physical domain 0.86, social-emotional (SE) domain 0.84, cognitive domain 0.75, and utility score 0.90. A history of epileptic crises was a predictive factor for a worse score overall and in the SE and cognitive domains. Factors related to a worse score in the physical domain were a previous shunt, the number of procedures, and the etiology and type of hydrocephalus. The mean follow-up duration from ETV to the last office visit was 5 years (64.5 months). No association was found between the degree of ventricular reduction and the quality of life.CONCLUSIONSThe factors related to a worse score in the different dimensions of the HOQ were a history of epileptic seizures, the number of procedures, communicating hydrocephalus, and having had a previous valve. No association was found between the reduction in ventricular size and the quality of life as measured on the HOQ-Sv.

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Clinical Outcome, Cognitive Function, and Quality of Life after Endoscopic Third Ventriculostomy versus Ventriculo-Peritoneal Shunt in Non-Tumor Hydrocephalus

Neurology India ◽

10.4103/0028-3886.332271 ◽

2021 ◽

Vol 69 (8) ◽

pp. 556

Author(s):

Sivashanmugam Dhandapani ◽

Manju Dhandapani ◽

NishantS Yagnick ◽

Manju Mohanty ◽

ChiragK Ahuja

Keyword(s):

Quality Of Life ◽

Cognitive Function ◽

Clinical Outcome ◽

Endoscopic Third Ventriculostomy ◽

Third Ventriculostomy ◽

Ventriculo Peritoneal Shunt

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Improved Sinonasal Quality of Life Outcomes Following Endoscopic Endonasal Repair of Spontaneous Cerebrospinal Fluid Leaks

10.1055/s-0040-1702709 ◽

2020 ◽

Author(s):

Feras Y. Ackall ◽

Lyndon Chan ◽

Kevin Choi ◽

Jordan Teitelbaum ◽

Patrick Codd ◽

...

Keyword(s):

Quality Of Life ◽

Cerebrospinal Fluid ◽

Life Outcomes ◽

Endoscopic Endonasal ◽

Quality Of Life Outcomes ◽

Cerebrospinal Fluid Leaks

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Fourth Ventricle Outlet Obstruction and Diverticular Enlargement of Luschka Foramina in a Child with Down Syndrome

Pediatric Neurosurgery ◽

10.1159/000511088 ◽

2020 ◽

pp. 1-4

Author(s):

Valentina Orlando ◽

Pietro Spennato ◽

Maria De Liso ◽

Vincenzo Trischitta ◽

Alessia Imperato ◽

...

Keyword(s):

Down Syndrome ◽

Fourth Ventricle ◽

Endoscopic Third Ventriculostomy ◽

Obstructive Hydrocephalus ◽

Radiological Finding ◽

Outlet Obstruction ◽

Third Ventriculostomy ◽

Viable Option ◽

Case Presentation

Introduction: Hydrocephalus is not usually part of Down syndrome (DS). Fourth ventricle outlet obstruction is a rare cause of obstructive hydrocephalus, difficult to diagnose, because tetraventricular dilatation may suggest a communicant/nonobstructive hydrocephalus. Case Presentation: We describe the case of a 6-year-old boy with obstructive tetraventricular hydrocephalus, caused by Luschka and Magendie foramina obstruction and diverticular enlargement of Luschka foramina (the so-called fourth ventricle outlet obstruction) associated with DS. He was treated with endoscopic third ventriculostomy (ETV) without complications, and a follow-up MRI revealed reduction of the ventricles, disappearance of the diverticula, and patency of the ventriculostomy. Conclusion: Diverticular enlargement of Luschka foramina is an important radiological finding for obstructive tetraventricular hydrocephalus. ETV is a viable option in tetraventricular obstructive hydrocephalus in DS.

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GCT-53. CASE OF INTRACRANIAL GROWING TERATOMA SYNDROME WITH DIFFICULTY IN TIMING OF RESECTION

Neuro-Oncology ◽

10.1093/neuonc/noaa222.271 ◽

2020 ◽

Vol 22 (Supplement_3) ◽

pp. iii339-iii339

Author(s):

Hidenobu Yoshitake ◽

Hideo Nakamura ◽

Yuta Hamamoto ◽

Yusuke Otsu ◽

Jin Kikuchi ◽

...

Keyword(s):

Radiation Therapy ◽

Endoscopic Third Ventriculostomy ◽

Obstructive Hydrocephalus ◽

Mature Teratoma ◽

Timing Of Surgery ◽

Optimal Timing ◽

Third Ventriculostomy ◽

Mixed Tumor ◽

Gland Tumor ◽

Growing Teratoma Syndrome

Abstract BACKGROUND Intracranial Growing teratoma syndrome(iGTS) is a phenomenon in which a tumor with a teratoma component grows during treatment, and its pathological tissue is often a mature teratoma. Here we report a case of iGTS in which the timing of surgery was determined by tumor markers and changes in tumor size on MRI images. CASE-REPORT: 11-year-old boy with a short stature. He developed a headache and we found a pineal gland tumor on MRI. Due to obstructive hydrocephalus, an endoscopic third ventriculostomy and biopsy were performed. The pathological diagnosis was mature teratoma, but AFP was elevated at 104.2 ng/mL. Considering NGGCT, we started chemoradiation immediately. Despite the declining AFP, it gradually increased, at which point we suspected iGTS. Resection was considered, but at some point tumor growth had stopped, so radiation therapy and a second course of ICE therapy preceded the resection. Thereafter, the tumor was completely removed, and a third course of ICE therapy was performed. DISCUSSION The onset mechanism of iGTS has not been elucidated, and its prediction is difficult. Early resection of the tumor is required, but discontinuation of radiation therapy and side effects of chemotherapy also need to be considered. In our case, resection was performed after normalization of AFP and recovery of myelosuppression. The patient followed an uneventful course, but the timing of resection was controversial. CONCLUSION We experienced a case of iGTS in NGGCT, a mixed tumor with mature teratoma. The optimal timing of the resection was discussed and literature was reviewed.

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