Third Ventriculostomy in Communicating Hydrocephalus in Adult Patients - The Role of Lumbar and Cranial Cerebrospinal Fluid Outflow Measurement

Introduction: Hydrocephalus is the accumulation of fluid in the cavities deep within the brain. The extra fluids cause the ventricles to expand, putting pressure on the brain. The brain and spinal column are bathed in cerebrospinal fluid, which usually flows into the ventricles. Excessive cerebrospinal fluid pressure caused by hydrocephalus, on the other hand, can harm brain tissues and result in a variety of cognitive impairments. Case Presentation: Here we have selected a case of hydrocephalus. In this case, when the complete history has been taken it found that patient having a history of NICU admission for prematurity and Low Birth Weight for 40 days. During history collection, it found that the child was all right until 4 months of age after which she started to notice that the child's head circumference was increasing at an abnormal rate and has now been brought to AVBRH for further management. After all investigation in MRI brain reveals extensive dilatation of ventricular system including bilateral lateral ventricle and III and IV ventricles associated with wide-open foramen of Luschka and Magendie with thinning of the adjacent cerebral cortex and cerebellar parenchyma. Features suggestive of communicating hydrocephalus. In the EEG record, the background record shows rhythmic synchronous > 13 Hz beta activity in the bilateral hemisphere. Abnormal EEG record. Then, the doctor planned for the Endoscopic Third Ventriculostomy with general anesthesia. Conclusion: In this study, we mainly focus on expert surgical management and excellent nursing care which leads to fast recovery of the patient. After a conversation with the patient, her response was positive and after nursing management and treatment, she was discharged without any postoperative complications and satisfaction of recovery.

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Role of Endoscopic Third Ventriculostomy in Shunt Malfunction

Indian Journal of Neurosurgery ◽

10.1055/s-0037-1601364 ◽

2017 ◽

Vol 06 (02) ◽

pp. 099-102 ◽

Cited By ~ 1

Author(s):

Shivender Sobti ◽

Ajay Choudhary ◽

Suryanaraynam Bhaskar ◽

Laxmi Gupta

Keyword(s):

Endoscopic Third Ventriculostomy ◽

Shunt Malfunction ◽

Shunt Revision ◽

Third Ventriculostomy ◽

Communicating Hydrocephalus ◽

New Delhi ◽

Contributing Factors ◽

Shunt Independence ◽

A Prospective Study

Background Shunt placement was a standard treatment for patients with hydrocephalus. The risk of shunt malfunction is quite high. Endoscopic third ventriculostomy (ETV) for hydrocephalus is an important advancement for patients with hydrocephalus. The aim is to study the role of ETV in patients with ventriculoperitoneal shunt malfunction. Methods A prospective study of 21 patients with shunt malfunction, who underwent secondary ETV instead of shunt revision, was conducted in Department of Neurosurgery, PGIMER, and Dr. RML Hospital, New Delhi. Patients data included age, cause of hydrocephalus, number of previous shunt surgeries, and outcome after ETV. Shunt was removed in all patients at the time of ETV. Success was defined as shunt independence till the last follow-up. Results There were 17 males and 4 females. The age range was 2 months to 53 years. Eleven patients had communicating and 10 patients had noncommunicating hydrocephalus. Overall success rate of ETV was 61.90% with 80% (8/10) in noncommunicating and 45.45% (5/11) in communicating hydrocephalus. None of the possible contributing factors for successful ETV, including age (p = 0.088), the etiology of hydrocephalus (p = 0.296), and number of previous shunt surgeries (p = 0.399), were statistically significantly correlated with outcome in our series. Overall complication rate was 14.2%. No death was reported. Conclusion ETV is an effective alternative for patients who present with shunt malfunction. Age, etiology, type of hydrocephalus, and number of shunt revisions did not have a significant impact on outcome of ETV.

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Panventriculomegaly with a wide foramen of Magendie and large cisterna magna

Journal of Neurosurgery ◽

10.3171/2015.6.jns15162 ◽

2016 ◽

Vol 124 (6) ◽

pp. 1858-1866 ◽

Cited By ~ 3

Author(s):

Hiroshi Kageyama ◽

Masakazu Miyajima ◽

Ikuko Ogino ◽

Madoka Nakajima ◽

Kazuaki Shimoji ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Quantitative Polymerase Chain Reaction ◽

Age At Onset ◽

Copy Number Variations ◽

Adult Patients ◽

Inversion Pulse ◽

Third Ventriculostomy ◽

Mri Findings ◽

Cisterna Magna ◽

Motile Cilia

OBJECT The authors’ goal in this paper is to provide the first clinical, radiological, and genetic studies of panventriculomegaly (PaVM) defined by a wide foramen of Magendie and large cisterna magna. METHODS Clinical and brain imaging data from 28 PaVM patients (including 10 patients from 5 families) were retrospectively studied. Five children were included. In adult patients, the age at onset was 56.0 ± 16.7 years. Tetraventricular dilation, aqueductal opening with flow void on T2-weighted images, and a wide foramen of Magendie and large cisterna magna (wide cerebrospinal fluid space at the fourth ventricle outlet) were essential MRI findings for PaVM diagnosis. 3D fast asymmetrical spin echo sequences were used for visualization of cistern membranes. Time-spatial labeling inversion pulse examination was performed to analyze cerebrospinal fluid movement. Copy number variations were determined using high-resolution microarray and were validated by quantitative polymerase chain reaction with breakpoint sequencing. RESULTS Adult patients showed gait disturbance, urinary dysfunction, and cognitive dysfunction. Five infant patients exhibited macrocranium. Patients were divided into 2 subcategories, those with or without downward bulging third ventricular floors and membranous structures in the prepontine cistern. Patients with bulging floors were successfully treated with endoscopic third ventriculostomy. Genetic analysis revealed a deletion in DNAH14 that encodes a dynein heavy chain protein associated with motile cilia function, and which co-segregated with patients in a family without a downward bulging third ventricular floor. CONCLUSIONS Panventriculomegaly with a wide foramen of Magendie and a large cisterna magna may belong to a subtype of congenital hydrocephalus with familial accumulation, younger age at onset, and symptoms of normal pressure hydrocephalus. In addition, a family with PaVM has a gene mutation associated with dysfunction of motile cilia.

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The role of third ventricle bowing in the success of endoscopic third ventriculostomy in pediatric and adult patients

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2019.105554 ◽

2019 ◽

Vol 187 ◽

pp. 105554 ◽

Cited By ~ 1

Author(s):

Tomáš Krejčí ◽

Ondřej Krejčí ◽

Zdeněk Večeřa ◽

Martin Chlachula ◽

Dana Šalounová ◽

...

Keyword(s):

Endoscopic Third Ventriculostomy ◽

Third Ventricle ◽

Adult Patients ◽

Third Ventriculostomy

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211 Macromolecular Clearance from the Ventricles by Choroid Plexus in Experimental Hydrocephalus

Neurosurgery ◽

10.1093/neuros/nyx417.211 ◽

2017 ◽

Vol 64 (CN_suppl_1) ◽

pp. 257-257

Author(s):

Satish Krishnamurthy ◽

Jie Li ◽

Yimin Shen ◽

Mark Haacke

Keyword(s):

Cerebrospinal Fluid ◽

Choroid Plexus ◽

Obstructive Hydrocephalus ◽

Spectrophotometric Assay ◽

Communicating Hydrocephalus ◽

Mri Scan ◽

Experimental Hydrocephalus ◽

Normal Rat ◽

Kinetics Of

Abstract INTRODUCTION Choroid plexus is known to be the source of cerebrospinal fluid and therefore, has been the target of surgical destruction or coagulation in the treatment of hydrocephalus. The role of choroid plexus in the homeostasis of the cerebrospinal fluid is unclear in the presence of hydrocephalus. METHODS We performed experiments to study the distribution and kinetics of iron labeled dextran in rats using a 7T MRI scan for a period of two hours during and immediately following injection. Rats were randomly divided into three groups: normal (n = 9), communicating hydrocephalus induced by kaolin (n = 11) and obstructive hydrocephalus induced by kaolin (n = 4). Presence of iron tagged dextran in the choroid plexus was determined as a change in the MRI signal (decreased T2 value) and histology after sacrifice of the animals. RESULTS >MR data was measured at three different time points: preinjection, 35 minutes post and 79 minutes post injection. We found that in all groups there was uptake of iron tagged dextran into the choroid plexus. While the T2 vlaues of CP returned baseline at 79 minutes in normal, while these values were still far below the baseline in kaolin induced hydrocephalus groups and these were statistically significant (P < 0.05). Normal rat, CP T2 values 101 ± 5(n = 18) (pre), 64 ± 1(35m post), 92 ± 1 (79m post). Hy-BC rat, CP T2 values 148 ± 26(n = 76) (pre), 60 ± 4(35m post), 71 ± 8(79m post). Hy-CM rat, CP T2 values156± 32(n = 53) (pre), 39 ± 6(35m post), 35 ± 4(79m post). Histopathology confirmed the presence of dextrans in the choroid plexus. Spectrophotometric assay of serum and urine revealed that dextrans were detected in both with a peak in the serum at 30 mins and peak in the urine at 45 mins. CONCLUSION Choroid plexus plays a beneficial role in the clearance of macromolecules from the CSF in both normal and hydrocephalic states.

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The Role of Endoscopic Third Ventriculostomy in the Treatment of Communicating Hydrocephalus

World Neurosurgery ◽

10.1016/j.wneu.2011.06.038 ◽

2012 ◽

Vol 77 (3-4) ◽

pp. 555-560 ◽

Cited By ~ 31

Author(s):

Leonardo Rangel-Castilla ◽

Sean Barber ◽

Yi Jonathan Zhang

Keyword(s):

Endoscopic Third Ventriculostomy ◽

Third Ventriculostomy ◽

Communicating Hydrocephalus

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The role of endoscopic third ventriculostomy in adult patients with hydrocephalus

Journal of Neurosurgery ◽

10.3171/2008.10.jns17667 ◽

2009 ◽

Vol 110 (5) ◽

pp. 861-866 ◽

Cited By ~ 65

Author(s):

Michael D. Jenkinson ◽

Caroline Hayhurst ◽

Mohammed Al-Jumaily ◽

Jothy Kandasamy ◽

Simon Clark ◽

...

Keyword(s):

Endoscopic Third Ventriculostomy ◽

Shunt Infection ◽

Adult Patients ◽

Shunt Malfunction ◽

Primary Group ◽

Third Ventriculostomy ◽

Aqueduct Stenosis ◽

Kaplan Meier ◽

Shunt Independence

Object Endoscopic third ventriculostomy (ETV) is the treatment of choice for hydrocephalus, but the outcome is dependent on the cause of this disorder, and the procedure remains principally the preserve of pediatric neurosurgeons. The role of ETV in adult patients with hydrocephalus was therefore investigated. Methods One hundred ninety adult patients underwent ETV for hydrocephalus. Cases were defined as primary ETV (newly diagnosed, without a previously placed shunt) and secondary ETV (performed for shunt malfunctions due to infection or mechanical blockage). Causes of hydrocephalus included tumor, long-standing overt ventriculomegaly (LOVA), Chiari malformation Types I and II (CM-I and -II), aqueduct stenosis, spina bifida, and intraventricular hemorrhage (IVH). Successful ETV was defined as resolution of symptoms with shunt independence. Operative complications and ETV failure rate were investigated according to the causes of hydrocephalus and between the primary and secondary ETV groups. Results In the primary group, ETV was successful in 107 (83%) of 129 patients, including those with tumors (52 of 66), LOVA (21 of 24), CM-I (11 of 11 cases), CM-II (8 of 9), aqueduct stenosis (8 of 9), and IVH (2 of 2). In the secondary group, ETV was successful in 41 (67%) of 61 patients and was equally successful in cases of mechanical shunt malfunction (35 of 52 patients) and infected shunt malfunction (6 of 9 patients). The median time to ETV failure was 1.7 months in the primary group and 0.5 months in the secondary group. The majority of ETV failures occurred within the first 3 months, and thereafter, the Kaplan-Meier survival curves plateaued. There were no procedure-related deaths, and complications were seen in only 5.8% of cases. Conclusions The success rate of ETVs in adults is comparable, if not better, than in children. In addition to the well-defined role of ETV in the treatment of hydrocephalus caused by tumors and aqueduct stenosis, ETV may also have a role in the management of CM-I, LOVA, persistent shunt infection, and IVH resistant to other CSF diversion procedures.

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