Endoscopic Third Ventriculostomy for the Treatment of Hydrocephalus in a Pediatric Population with Myelomeningocele

Background: Cavernous malformations prevalence ranges from 0.4 to 0.6% and accounts for 5–15% of all central nervous system vascular malformations. Pineal cavernomas constitute <1% of all locations published in the literature, with a total of 26 cases reported, only 5 regarding the pediatric population until 2020. Overall annual hemorrhage rate is 2.4%. Symptoms are often due to hydrocephalus and intracranial hypertension. Case Description: We report a case of a 5-year-old child with visual disturbances, headache, and progressive neurologic deterioration. MR showed a lesion in the pineal region and triventricular hydrocephalus. She was submitted to endoscopic third ventriculostomy and total excision of the lesion by the infratentorial supracerebellar approach a few days later. Histopathological examination confirmed a pineal cavernous malformation. The patient returned to her normal life without any neurologic deficit and a normal development. Conclusion: The ideal treatment is primary lesion removal; however, due to the infrequency and because it is a curable lesion, studies seeking to deepen the knowledge of this disease are considered relevant.

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Endoscopic third ventriculostomy in failed ventriculoperitoneal shunt in pediatric population

Asian Journal of Neurosurgery ◽

10.4103/ajns.ajns_117_20 ◽

2020 ◽

Vol 15 (4) ◽

pp. 937

Author(s):

Shivender Sobti ◽

Ajay Choudhary ◽

Sourabh Zambre ◽

Suryanarayanan Bhaskar

Keyword(s):

Ventriculoperitoneal Shunt ◽

Endoscopic Third Ventriculostomy ◽

Pediatric Population ◽

Third Ventriculostomy

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Flow diversion of a recurrent, iatrogenic basilar tip aneurysm in a pediatric patient: case report

Journal of Neurosurgery Pediatrics ◽

10.3171/2017.7.peds17235 ◽

2018 ◽

Vol 21 (1) ◽

pp. 90-93 ◽

Cited By ~ 5

Author(s):

Rahul A. Sastry ◽

Matthew J. Koch ◽

Benjamin L. Grannan ◽

Christopher J. Stapleton ◽

William E. Butler ◽

...

Keyword(s):

Endoscopic Third Ventriculostomy ◽

Pediatric Population ◽

Subsequent Development ◽

Flow Diversion ◽

Third Ventriculostomy ◽

Complication Rates ◽

Traumatic Pseudoaneurysm ◽

Noncommunicating Hydrocephalus ◽

Basilar Tip Aneurysm ◽

Vessel Reconstruction

Endoscopic third ventriculostomy (ETV) is a common treatment for noncommunicating hydrocephalus. Although rare, vascular injury and traumatic pseudoaneurysm development during ETV have been reported. The authors present the case of a 13-year-old boy who underwent repeat ETV (rETV) for shunt and ETV failure, and who suffered an intraoperative subarachnoid hemorrhage due to iatrogenic injury to the basilar tip, with subsequent development of a pseudoaneurysm. Despite initial primary coil embolization, the aneurysm recurred and was definitively treated with flow diversion. In this report, the authors review complication rates associated with ETV and rETV as well as the emerging use of flow diversion and its applications in vessel reconstruction within the pediatric population.

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The Role of the Liliequist Membrane in the Third Ventriculostomy

10.21203/rs.3.rs-171335/v1 ◽

2021 ◽

Author(s):

Jose Aloysio Costa Val Filho ◽

Sebastião Nataniel da Silva Gusmão ◽

Leopoldo Mandic Ferreira Furtado ◽

Guaracy de Macedo Machado Filho ◽

Fernando Levi Alencar Maciel

Keyword(s):

Success Rate ◽

Endoscopic Third Ventriculostomy ◽

Pediatric Population ◽

Difficulty Level ◽

Third Ventriculostomy ◽

Technical Parameters ◽

Hydrocephalus Treatment ◽

Endoscopic Third Ventriculostomy Success ◽

The Impact

Abstract Endoscopic third ventriculostomy (ETV) is a hydrocephalus treatment procedure that involves opening the Liliequist membrane (LM). However, LM anatomy has not been well-studied neuroendoscopically, because approach angles differ between descriptive and microsurgical anatomical explorations. Discrepancies in ETV efficacy, especially among children age 2 and younger, may be due to incomplete LM opening. The objective of this study was to characterize the LM anatomically from a neuroendoscopic perspective to better understand the impact of anatomical features during LM ostomy and the ETV success rate. Additionally, the ETV success score was tested to predict patient outcome after the intraoperatively difficult opening of LM. Fifty-four patients who underwent ETV were prospectively analyzed with a mean follow-up of 53.1 months (1–90 months). The ETV technical parameters of difficulty were validated by seven expert neurosurgeons. The pediatric population (44) of this study represents the majority of patients (81.4%). The overall ETV success rate was 68.5%. Anomalies on the IIIVT floor resulted in an increased rate of ETV failure. The IIIVT was anomalous, and LM was thick in 33.3% of cases. Fenestration of LM was difficult in 39% of cases, and the LM and TC were opened separately in 55.6% of cases. The endoscopic third ventriculostomy success score (ETVSS) accurately predicted the level of difficulty opening the LM (p = 0.012), and the group with easy opening presented greater durability in ETV success. Neurosurgeons should be aware of the difficulty level of the overture of LM during ETV and its impact on long-term ETV effectiveness.

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Endoscopic Third Ventriculostomy in 250 Adults With Hydrocephalus

Neurosurgery ◽

10.1227/neu.0000000000000994 ◽

2015 ◽

Vol 78 (1) ◽

pp. 109-119 ◽

Cited By ~ 28

Author(s):

Walter Grand ◽

Jody Leonardo ◽

Andrea J. Chamczuk ◽

Adam J. Korus

Keyword(s):

Intraventricular Hemorrhage ◽

Endoscopic Third Ventriculostomy ◽

Pediatric Population ◽

Adult Population ◽

Residual Tumor ◽

Normal Pressure ◽

Third Ventriculostomy ◽

Communicating Hydrocephalus ◽

Cerebrospinal Fluid Diversion ◽

Patient Selection Criteria

Abstract BACKGROUND: Endoscopic third ventriculostomy (ETV) has been used predominantly in the pediatric population in the past. Application in the adult population has been less extensive, even in large neurosurgical centers. To our knowledge, this report is one of the largest adult ETV series reported and has the consistency of being performed at 1 center. OBJECTIVE: To determine the efficacy, safety, and outcome of ETV in a large adult hydrocephalus patient series at a single neurosurgical center. In addition, to analyze patient selection criteria and clinical subgroups (including those with ventriculoperitoneal shunt [VPS] malfunction or obstruction and neurointensive care unit patients with extended ventricular drainage before ETV) to optimize surgical results in the future. METHODS: We conducted a retrospective review of adult ETV procedures performed at our center between 2000 and 2014. RESULTS: The overall rate of success (no further cerebrospinal fluid diversion procedure performed plus clinical improvement) of 243 completed ETVs was 72.8%. Following is the number of procedures with the success rate in parentheses: aqueduct stenosis, 56 (91%); communicating hydrocephalus including normal pressure hydrocephalus, nonnormal pressure hydrocephalus, and remote head trauma, 57 (43.8%); communicating hydrocephalus in postoperative posterior fossa tumor without residual tumor, 14 (85.7%); communicating hydrocephalus in subarachnoid hemorrhage without intraventricular hemorrhage, 23 (69.6%); obstruction from tumor/cyst, 42 (85.7%); VPS obstruction (diagnosis unknown), 23 (65.2%); intraventricular hemorrhage, 20 (90%); and miscellaneous (obstructive), 8 (50%). There were 9 complications in 250 intended procedures (3.6%); 5 (2%) were serious. CONCLUSION: Use of ETV in adult hydrocephalus has broad application with a low complication rate and reasonably good efficacy in selected patients.

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Endoscopic third ventriculostomy for tumor-related hydrocephalus in a pediatric population

Neurosurgical FOCUS ◽

10.3171/foc.2005.19.6.9 ◽

2005 ◽

Vol 19 (6) ◽

pp. 1-4 ◽

Cited By ~ 48

Author(s):

Pulak Ray ◽

George I. Jallo ◽

R. Y. H. Kim ◽

Bong-Soo Kim ◽

Sean Wilson ◽

...

Keyword(s):

Success Rate ◽

Patency Rate ◽

Endoscopic Third Ventriculostomy ◽

Pediatric Population ◽

Obstructive Hydrocephalus ◽

Management Tool ◽

Third Ventriculostomy ◽

Pineal Tumor ◽

Success Rates ◽

Primary Procedure

Object Endoscopic third ventriculostomy (ETV) has become a common alternative for managing hydrocephalus in select patients. Nevertheless, there is still controversy regarding the indications for ETV as the primary procedure, given its variable success rates. The purpose of this study is to review the authors' experience with ETV for a variety of patients. Methods A total of 43 children underwent ETV between July 1992 and June 2003. Their medical records, operative reports, and imaging studies, when available, were retrospectively reviewed with regard to outcome, complications, and patency rate. Treatment failure was defined as the need to place a shunt within 4 weeks of performing ETV in the patient. There were 20 male and 23 female patients with a mean age of 9.6 years (range 8 weeks–21 years). The overall success rate was 69.8%, and the mean follow-up duration was 24.6 months. Six patients underwent eight repeated ETVs at a mean interval of 25 months, with a patency rate of 62.5% after the second procedure. Only two surgeries were aborted for anatomical reasons. The highest success rates (100% in each instance) were achieved for obstructive hydrocephalus resulting from midbrain/tectal tumor (four patients) and pineal tumor (three patients). Conclusions The ETV procedure is an effective management tool for obstructive hydrocephalus in children. It should be considered the primary procedure, rather than ventriculoperitoneal shunts, in carefully selected children. The success rate is dependent on the origin of the hydrocephalus.

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