PND55 ECONOMIC EVALUATION OF ENDOSCOPIC THIRD VENTRICULOSTOMY COMPARED TO SHUNTING IN PEDIATRIC PATIENTS WITH HYDROCEPHALUS IN UZBEKISTAN

Endoscopic third ventriculostomy (ETV) is a routine and safe procedure for therapy of obstructive hydrocephalus. The aim of our study is to evaluate ETV success rate in therapy of obstructive hydrocephalus in pediatric patients formerly treated by ventriculoperitoneal (V-P) shunt implantation. From 2001 till 2011, ETV was performed in 42 patients with former V-P drainage implantation. In all patients, the obstruction in aqueduct or outflow parts of the fourth ventricle was proved by MRI. During the surgery, V-P shunt was clipped and ETV was performed. In case of favourable clinical state and MRI functional stoma, the V-P shunt has been removed 3 months after ETV. These patients with V-P shunt possible removing were evaluated as successful. In our group of 42 patients we were successful in 29 patients (69%). There were two serious complications (4.7%)—one patient died 2.5 years and one patient died 1 year after surgery in consequence of delayed ETV failure. ETV is the method of choice in obstructive hydrocephalus even in patients with former V-P shunt implantation. In case of acute or scheduled V-P shunt surgical revision, MRI is feasible, and if ventricular system obstruction is diagnosed, the hydrocephalus may be solved endoscopically.

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Endoscopic Transventricular Transaqueductal Magendie and Luschka Foraminoplasty for Hydrocephalus

Neurosurgery ◽

10.1227/neu.0000000000000283 ◽

2013 ◽

Vol 74 (4) ◽

pp. 426-436 ◽

Cited By ~ 15

Author(s):

Jaime Torres-Corzo ◽

Juan Sánchez-Rodríguez ◽

Dominic Cervantes ◽

Roberto Rodríguez-Della Vecchia ◽

Fernando Muruato-Araiza ◽

...

Keyword(s):

Pediatric Patients ◽

Endoscopic Third Ventriculostomy ◽

Outlet Obstruction ◽

Third Ventriculostomy ◽

Alternative Technique ◽

Vp Shunt ◽

Long Term Follow Up ◽

Secondary Causes

ABSTRACT BACKGROUND: Routinely, hydrocephalus related to fourth ventricular outlet obstruction (FVOO) has been managed with ventriculoperitoneal (VP) shunting or endoscopic third ventriculostomy (ETV). Few reports on Magendie foraminoplasty exist, and Luschka foraminoplasty has not been described. OBJECTIVE: To present an alternative technique in the management of FVOO via an endoscopic transventricular transaqueductal Magendie and Luschka foraminoplasty and to discuss the indications, technique, findings, and outcomes. METHODS: Between 1994 and 2011, all patients who underwent endoscopic Magendie and Luschka foraminoplasty were analyzed. RESULTS: A total of 33 Magendie (28) and/or Luschka (5) foraminoplasties were performed in 30 patients. Twenty-three were adult and 7 were pediatric patients. The etiology of the FVOO was divided into primary etiologies (congenital membrane in 5 and atresia in 2) and secondary causes (neurocysticercosis in 14 patients, bacterial meningitis in 9). Fifteen (50%) had previously failed procedures. Intraoperative findings that led to Magendie/Luschka foraminoplasty were ETV not feasible to perform, nonpatent basal subarachnoid space, or primary FVOO. Minor postoperative complications were seen in 3 patients. Only 26 patients had long-term follow-up; 17 (65.3%) of these had clinical improvement and did not require further procedures. Nine (34.7%) did not improve. Eight required another procedure (7 shunts, and 1 endoscopic procedure). One patient died. CONCLUSION: Flexible neuroendoscopic transventricular transforaminal Magendie and Luschka foraminoplasty is feasible and safe. These procedures may prove to be viable alternatives to standard ETV and VP shunt in appropriate patients. Adequate intraoperative assessment of ETV success is necessary to identify patients who will benefit.

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Endoscopic Third Ventriculostomy in Pediatric Patients: The Canadian Experience

Neurosurgery ◽

10.1227/01.neu.0000255420.78431.e7 ◽

2007 ◽

Vol 60 (5) ◽

pp. 881-886 ◽

Cited By ~ 122

Author(s):

James M. Drake

Keyword(s):

Pediatric Patients ◽

Endoscopic Third Ventriculostomy ◽

Cox Model ◽

Pediatric Neurosurgery ◽

Third Ventriculostomy ◽

Time To Failure ◽

Success Rates ◽

Accurate Analysis ◽

Young Infants ◽

Small Series

Abstract OBJECTIVE Reports from relatively small series of pediatric patients predominantly from single centers have hampered accurate analysis of outcome from endoscopic third ventriculostomy. We combined patients from nine pediatric neurosurgery centers across Canada to obtain a better estimate of outcome and identify factors affecting success of the procedure. METHODS Databases were recoded for uniformity. Failure of the procedure was defined as any subsequent operation or death resulting from hydrocephalus. Time to failure was analyzed by Kaplan-Meier estimate and Cox proportional hazard analysis. RESULTS During a 15-year period (1989–2004), 368 patients underwent the procedure. The average age was 6.5 years, and 57% were male. Aqueduct stenosis and tumors were the most common etiology, comprising 34 and 29%, respectively. Twenty-two percent of the patients had been previously shunted. The 1- and 5-year success rates were 65 and 52%, respectively. Factors included in the Cox model were age, sex, etiology of hydrocephalus, previous surgery, center volume, and surgeon volume. By multivariate analysis, only age had a significant effect on outcome, with younger patients failing at higher rates, particularly neonates and infants. CONCLUSION Based on data from multiple Canadian centers, age seems to be the primary determinant of outcome in endoscopic third ventriculostomy in pediatric patients. Failure rates are particularly high in neonates and young infants; thus, the role of this procedure in this age group should be carefully considered.

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Changes in third ventricular size in pediatric patients undergoing endoscopic third ventriculostomy

Child s Nervous System ◽

10.1007/s00381-013-2145-1 ◽

2013 ◽

Vol 29 (11) ◽

pp. 2027-2034 ◽

Cited By ~ 8

Author(s):

Jonathan Pindrik ◽

George I. Jallo ◽

Edward S. Ahn

Keyword(s):

Pediatric Patients ◽

Endoscopic Third Ventriculostomy ◽

Third Ventriculostomy ◽

Ventricular Size

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Progressive Hydrocephalus after Endoscopic Third Ventriculostomy in Pediatric Patients with Blake’s Pouch Cyst

NMC Case Report Journal ◽

10.2176/nmccrj.cr.2019-0263 ◽

2020 ◽

Vol 7 (3) ◽

pp. 141-145

Author(s):

Youhei Takeuchi ◽

Tomomi Kimiwada ◽

Reizo Shirane ◽

Teiji Tominaga

Keyword(s):

Pediatric Patients ◽

Endoscopic Third Ventriculostomy ◽

Third Ventriculostomy

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Successful management of symptomatic hydrocephalus using a temporary external ventricular drain with or without endoscopic third ventriculostomy in pediatric patients with germinoma

Journal of Neurosurgery ◽

10.3171/2021.8.jns211443 ◽

2021 ◽

pp. 1-6

Author(s):

Rebecca Ronsley ◽

Eric Bouffet ◽

Peter Dirks ◽

James Drake ◽

Abhaya Kulkarni ◽

...

Keyword(s):

Pediatric Patients ◽

Endoscopic Third Ventriculostomy ◽

External Ventricular Drain ◽

Retrospective Chart Review ◽

Progression Free Survival ◽

Tumor Location ◽

Third Ventriculostomy ◽

Timely Initiation ◽

Vp Shunt ◽

Csf Diversion

OBJECTIVE The objective of this study was to describe the management of hydrocephalus in a cohort of pediatric patients with germinoma. METHODS The authors conducted a retrospective chart review of patients with germinoma and symptomatic hydrocephalus treated at the Hospital for Sick Children between 2002 and 2020. Descriptive data included tumor location, CSF diversion procedure (external ventricular drain [EVD], endoscopic third ventriculostomy [ETV], ventriculoperitoneal [VP] shunt) and outcomes. The frontooccipital horn ratio (FOR) method was used to determine the presence of ventriculomegaly. RESULTS Of 39 patients with germinoma, 22 (73% male) had symptomatic hydrocephalus at diagnosis (11 pineal, 4 suprasellar, and 7 bifocal). Management of hydrocephalus included EVD (n = 5, 22.7%), ETV (n = 5, 22.7%), and combination ETV and EVD (n = 7, 31.8%), whereas 5 patients (22.7%) did not undergo surgical intervention. The median FOR at diagnosis was 0.42 (range 0.38–0.58), which correlated with moderate to severe ventriculomegaly. Carboplatin and etoposide–based chemotherapy induced fast tumor shrinkage, avoiding CSF diversion (n = 5) and resolving hydrocephalus with a transient EVD (n = 5). The median duration until EVD removal was 7 days (range 2–10 days). Two of 12 patients with EVD ultimately required a VP shunt. Kaplan-Meier overall survival was 100% and progression-free survival was 96.4% at a median follow-up of 10.4 years. CONCLUSIONS Timely initiation of chemotherapy is imperative to rapidly reduce tumor bulk in children with germinoma and limits the need for VP shunt insertions. In children in whom CSF diversion is required, hydrocephalus may be successfully managed with a temporary EVD ± ETV.

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