An optimized technique of endoscopic third ventriculocisternostomy (ETV) for children with occlusive hydrocephalus

Abstract OBJECTIVE: The surgical management of occlusive hydrocephalus caused by massive cerebellar infarction remains controversial. The procedures that are more commonly used to avoid progressive neurological deterioration are based on transient external ventricular drainage or the placement of permanent shunt systems. To our knowledge, this is the first report regarding using endoscopic third ventriculostomy (ETV) in patients with an occlusive hydrocephalus caused by cerebellar ischemic stroke. We report our experience of 10 reviewed cases. METHODS: Between 1997 and 2004, 10 patients with a resulting hydrocephalus caused by a space-occupying cerebellar infarction were managed with ETV. Glasgow Coma Scale score on admission, cause of stroke, and computed tomographic signs, including the ischemic vascular territory involved and brain edema, were noted. Clinical outcome was evaluated using the Glasgow Outcome Scale. RESULTS: In all patients, there was a mean interval of 4 days from the onset of deterioration of consciousness to operation. Mean Glasgow Coma Scale score on admission was 11.2. In nine patients, ETV was the initial procedure of ventricular drainage. One patient was primarily treated with an external ventricular drainage, but the device dislocated and ETV was performed. In one patient, an external ventricular drainage became necessary 7 days after the initial ETV because of a malfunction of the stoma. One patient showed a progressive brain edema 2 days after ETV, and suboccipital decompression was performed. Eight successfully treated patients demonstrated an improvement in the level of consciousness after ETV. Mean Glasgow Outcome Scale score on discharge of all patients was 3.4. CONCLUSION: Occlusive hydrocephalus caused by cerebellar infarction is infrequent. When occlusive hydrocephalus is observed, ETV can be used successfully with minimal risks, especially with avoidance of a higher rate of infectious complications caused by external drainage systems.

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Cerebrospinal fluid ceftazidime kinetics in patients with external ventriculostomies.

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.40.3.763 ◽

1996 ◽

Vol 40 (3) ◽

pp. 763-766 ◽

Cited By ~ 18

Author(s):

R Nau ◽

H W Prange ◽

M Kinzig ◽

A Frank ◽

A Dressel ◽

...

Keyword(s):

Central Nervous System ◽

Cerebrospinal Fluid ◽

Nervous System ◽

High Performance ◽

Elimination Half ◽

Daily Dose ◽

Order Of Magnitude ◽

The Central Nervous System ◽

Occlusive Hydrocephalus ◽

A Minor

Ceftazidime has proven to be effective for the treatment of bacterial meningitis caused by multiresistant gram-negative bacteria. Since nosocomial central nervous system infections are often accompanied by only a minor dysfunction of the blood-cerebrospinal fluid (CSF) barrier, patients with noninflammatory occlusive hydrocephalus who had undergone external ventriculostomy were studied (n = 8). Serum and CSF were drawn repeatedly after the administration of the first dose of ceftazidime (3 g over 30 min intravenously), and concentrations were determined by high-performance liquid chromatography by using UV detection. The concentrations of ceftazidime in CSF were maximal at 1 to 13 h (median, 5.5 h) after the end of the infusion and ranged from 0.73 to 2.80 mg/liter (median, 1.56 mg/liter). The elimination half-lives were 3.13 to 18.1 h (median, 10.7 h) in CSF compared with 2.02 to 5.24 h (median, 3.74 h) in serum. The ratios of the areas under the concentration-time curves in CSF and serum (AUCCSF/AUCS) ranged from 0.027 to 0.123 (median, 0.054). After the administration of a single dose of 3 g, the maximum concentrations of ceftazidime in CSF were approximately four times higher than those after the administration of 2-g intravenous doses of cefotaxime (median, 0.44 mg/liter) and ceftriaxone (median, 0.43 mg/liter) (R. Nau, H. W. Prange, P. Muth, G. Mahr, S. Menck, H. Kolenda, and F. Sörgel, Antimicrob. Agents Chemother. 37:1518-1524, 1993). The median AUCCSF/AUCS ratio of ceftazidime was slightly below that of cefotaxime (0.12), but it was 1 order of magnitude above the median AUCCSF/AUCS of ceftriaxone (0.007) (Nau et al., Antimicrob. Agents Chemother. 37:1518-1524, 1993). The concentrations of ceftazidime observed in CSF were above the MICs for most Pseudomonas aeruginosa strains. However, they are probably not high enough to be rapidly bactericidal. For this reason, the daily dose should be increased to 12 g in cases of P. aeruginosa infections of the central nervous system when the blood-CSF barrier is minimally impaired.

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Secondary amenorrhea due to hydrocephalus treated with endoscopic ventriculocisternostomy

Journal of Neurosurgery ◽

10.3171/jns.1996.85.6.1148 ◽

1996 ◽

Vol 85 (6) ◽

pp. 1148-1152 ◽

Cited By ~ 22

Author(s):

David W. Lowry ◽

Donna L. B. Lowry ◽

Sarah L. Berga ◽

P. David Adelson ◽

Michelle M. Roberts

Keyword(s):

Aqueductal Stenosis ◽

Review Of The Literature ◽

Content Type ◽

Secondary Amenorrhea ◽

Noncommunicating Hydrocephalus ◽

Normal Menstruation ◽

Endoscopic Third Ventriculocisternostomy ◽

Fine Print

✓ The authors present a case of secondary amenorrhea in a 32-year-old woman found to have noncommunicating hydrocephalus due to aqueductal stenosis. Although the presentation of hydrocephalus with amenorrhea has been previously reported, this association remains rare. After treatment via endoscopic third ventriculocisternostomy, the patient resumed normal menstruation and all hormonal abnormalities have resolved except hypothyroidism. A review of the literature on the etiology of endocrinological disturbances in patients with hydrocephalus is presented.

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Endoscopic third ventriculostomy for shunt dysfunction in occlusive hydrocephalus: long-term follow up and review

Journal of Neurosurgery ◽

10.3171/jns.2003.98.5.1032 ◽

2003 ◽

Vol 98 (5) ◽

pp. 1032-1039 ◽

Cited By ~ 89

Author(s):

Jürgen Boschert ◽

Dieter Hellwig ◽

Joachim K. Krauss

Keyword(s):

Endoscopic Third Ventriculostomy ◽

Obstructive Hydrocephalus ◽

The Other ◽

Third Ventriculostomy ◽

Content Type ◽

Shunt Placement ◽

Occlusive Hydrocephalus ◽

Shunt Dysfunction ◽

Fine Print

Object. Endoscopic third ventriculostomy (ETV) is the treatment of choice for occlusive (noncommunicating) hydrocephalus. Nevertheless, its routine use in patients who have previously undergone shunt placement is still not generally accepted. The authors' aim was to investigate the long-term effects of ETV in a group of prospectively chosen patients. Methods. Patients who underwent ETV and had previously undergone shunt placement for occlusive hydrocephalus were followed prospectively for at least 3 years (range 36–103 months, mean 63.6 months). Nine female and eight male patients ranging from 8 to 54 years of age (mean 32 years) had undergone shunt placement 0.7 to 23.5 years (mean 8.1 years) before ETV. Fifteen patients were admitted with underdrainage and two with overdrainage. In six cases, ETV was performed as an emergency operation. The origin of hydrocephalus was aqueductal stenosis in 12 cases and aqueductal compression by a tumor in two cases. Three patients suffered from a fourth ventricle outlet syndrome, and in two patients an additional malresorptive component was suspected. Thirteen patients underwent ETV with shunt removal and insertion of an external drain in one session. The drain served as a safety measure; it could be opened if raised intracranial pressure or ventricular dilation was observed on postoperative imaging studies. In the other four patients the shunt was initially ligated and then removed during a second operation. Fourteen patients (82%) have remained shunt free. The other three patients, including the two with an additional malresorptive component, needed shunt reimplantation 3 days, 2 weeks, or 7 months after ETV. Conclusions. Use of ETV is safe and effective for the treatment for shunt dysfunction in patients with obstructive hydrocephalus.

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