Neuroendoscopic Procedures in Achievement of Shunt Independence: Outcome Analysis of 28 Patients with Shunt Malfunction

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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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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Endoscopic third ventriculostomy: an outcome analysis of primary cases and procedures performed after ventriculoperitoneal shunt malfunction

Yearbook of Neurology and Neurosurgery ◽

10.1016/s0513-5117(08)70228-x ◽

2007 ◽

Vol 2007 ◽

pp. 331-332

Author(s):

M.R. Proctor

Keyword(s):

Ventriculoperitoneal Shunt ◽

Endoscopic Third Ventriculostomy ◽

Shunt Malfunction ◽

Outcome Analysis ◽

Third Ventriculostomy

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573: Radical Cystectomy in Hispanic Patients: An Outcome Analysis

The Journal of Urology ◽

10.1016/s0022-5347(18)30813-9 ◽

2007 ◽

Vol 177 (4S) ◽

pp. 191-191

Author(s):

Murugesan Manoharan ◽

Srinivas Samavedi ◽

Rajinikanth Ayyathurai ◽

Sachin Vyas ◽

Mark S. Soloway

Keyword(s):

Radical Cystectomy ◽

Outcome Analysis ◽

Hispanic Patients

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Three year results of endovascular therapy with a new generation nitinol stent for femoro-popliteal artery lesions - a single-center outcome analysis of a subcohort of MISAGO 2 study

VASA ◽

10.1024/0301-1526/a000299 ◽

2013 ◽

Vol 42 (5) ◽

pp. 340-349 ◽

Cited By ~ 9

Author(s):

Ivan Kralj ◽

Irene Boos ◽

Uwe Müller-Bühl

Keyword(s):

Popliteal Artery ◽

Clinical Success ◽

Ankle Brachial Index ◽

Long Term Results ◽

Outcome Analysis ◽

Stent Fracture ◽

Nitinol Stent ◽

New Generation ◽

Stent Stenosis

Background: Advances in stent technology have widened the field of indications for stent treatment of femoro-popliteal artery lesions, however the use of stents in bending arterial segments is restricted because some first- and second-generation nitinol stent designs did not respond well to the mechanical forces of femoro-popliteal segments in motion which pose a substantial risk of stent fracture inducing in-stent-stenosis. New generation nitinol stents are supposed to overcome these limitations but long-term results are rare. Patients and methods: In forty-five patients (mean age 68 y, range 50 - 85) with peripheral arterial disease (TASC II A-C, Rutherford category 2 - 5) forty-six lesions of the superficial femoral artery (37) or popliteal artery (9) were treated [25 high-grade stenoses, mean length 53 mm (range 30 - 145 mm); 21 chronic total occlusions, mean length 74 mm (range 30 - 180 mm)]. 74 % of lesions were located in the mobile bending arterial segments in the distal femoral or the popliteal segment. Clinical reevaluation performed at discharge, at 6, 12, 24, and 36 months included at least the measurement of ankle-brachial index (ABI) and duplex sonography. Results: Procedural success rate was 100 %. At 6, 12, 24, and 36 months, cumulative primary patency rate was 93.5 %, 84.8 %, 80.5 %, and 74.3 % (SE<10); freedom from target lesion revascularization rate was 95.7 %, 89.2 %, 84.9 %, and 79.3 % (SE<10); Rutherford category and ABI improved in all patients and clinical success was maintained in more than 85 % of patients. Conclusions: Sustained technical and clinical success and good clinical long-term results were achieved with Misago™ nitinol stent implantation in femoro-popliteal lesions with moderate risk for in-stent-stenosis, and in the distal femoral and popliteal mobile segment.

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