Endoscopic Third Ventriculostomy for Hydrocephalus Secondary to Extraventricular Obstruction in Thalamic Hemorrhage: A Case Series

Abstract BACKGROUND Intracranial hemorrhage carries significant morbidity and mortality, particularly if associated with hydrocephalus. Management of hydrocephalus includes temporary external ventricular drainage, with or without shunting. Thalamic location is an independent predictor of mortality and increases the likelihood of shunt dependence. OBJECTIVE To determine whether endoscopic third ventriculostomy (ETV) can avoid the need for shunt placement and expedite recovery. METHODS We prospectively identified thalamic intracranial hemorrhage patients who developed acute hydrocephalus requiring cerebrospinal fluid diversion by extraventricular drain placement from November 2017 to February 2019. Patients who failed an extraventricular drain clamping trial were then evaluated for eligibility for an ETV procedure. Patients who underwent ETV were then followed up for the development of hydrocephalus, need for shunting, and length of stay in the intensive care unit. RESULTS Eight patients (7 males, 1 female) were prospectively enrolled. All patients underwent an ETV successfully. None of the patients required shunting. ETV was performed despite the presence of other factors that would have prevented shunt placement, including fever, leukocytosis, and gastrostomy tube placement. Seven patients who underwent ETV were evaluated at 3-mo follow-up and did not require shunting. CONCLUSION ETV is a safe and effective technique for the management of hydrocephalus resulting from an extraventricular obstruction in thalamic hemorrhage. It can avoid the need for permanent shunting in this patient population. Larger studies should be conducted to validate and further analyze this intervention.

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Endoscopic third ventriculostomy for hydrocephalus in brainstem glioma: a case series

Child s Nervous System ◽

10.1007/s00381-016-3065-7 ◽

2016 ◽

Vol 32 (7) ◽

pp. 1251-1255 ◽

Cited By ~ 5

Author(s):

Natsuki Kobayashi ◽

Hideki Ogiwara

Keyword(s):

Endoscopic Third Ventriculostomy ◽

Case Series ◽

Brainstem Glioma ◽

Third Ventriculostomy

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Efficacy and Safety of Endoscopic Third Ventriculostomy in Obstructive Hydrocephalus

Nepal Journal of Neuroscience ◽

10.3126/njn.v14i2.19700 ◽

2017 ◽

Vol 14 (2) ◽

pp. 21-24

Author(s):

Sachidanad Gautam ◽

Sumit Kamble

Keyword(s):

Success Rate ◽

Endoscopic Third Ventriculostomy ◽

Obstructive Hydrocephalus ◽

Case Series ◽

Cost Effective ◽

Third Ventriculostomy ◽

Safe Procedure ◽

Success Rates ◽

Replacement Procedure ◽

Ventricular Hemorrhage

Endoscopic third ventriculostomy is the procedure of choice to treat obstructive hydrocephalus now a days. Published case series of endoscopic third ventriculostomy (ETV) for childhood hydrocephalus have reported widely varying success rates. The purpose of this study is to determine the success rate and complications of ETV for treating obstructive hydrocephalus.Patients with obstructive hydrocephalus and already shunted patients for obstructive hydrocephalus presented with blocked shunt were included in the study. The exclusion criteria consisted ofrecurrent tumor or intra ventricular hemorrhage. Endoscopic third ventriculostomy was performed. Patients were followed up for one year and Clinical and Radiological improvement, complications and mortality was noted. This study was conducted in Neurosurgery Department, Govt. Medical College, Kota between 2015-2016.There were 56 patients including 36 males and 20females. Success rate in the form of clinical and/ or radiological improvement was seen in 88.8% 0f patients. Complications were seen in 6 patients including ETV failure and ventricular hemorrhage. There was no mortality during follow up period of 1 year.ETV is cost effective and safe procedure in patients with obstructive hydrocephalus with good outcome. It may be used as replacement procedure of ventriculo-peritoneal shunt as initial line of management in selected patients based on ETV score. Nepal Journal of Neuroscience, Vol. 14, No. 2, 2017 Page: 21-24

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Postoperative seizures following endoscopic third ventriculostomy and choroid plexus cauterization: a case series

Journal of Neurosurgery Pediatrics ◽

10.3171/2021.8.peds21169 ◽

2021 ◽

pp. 1-7

Author(s):

Randaline R. Barnett ◽

Allie L. Harbert ◽

Hengameh B. Pajer ◽

Angela Wabulya ◽

Valerie L. Jewells ◽

...

Keyword(s):

Choroid Plexus ◽

Endoscopic Third Ventriculostomy ◽

Medical Center ◽

Academic Medical Center ◽

Case Series ◽

Third Ventriculostomy ◽

Mri Findings ◽

Entry Site ◽

Postoperative Seizure ◽

Choroid Plexus Cauterization

OBJECTIVE In this study, the authors sought to investigate variables associated with postoperative seizures following endoscopic third ventriculostomy and choroid plexus cauterization (ETV/CPC) for treatment of pediatric hydrocephalus. METHODS A retrospective analysis of 37 patients who underwent ETV/CPC for treatment of hydrocephalus at an academic medical center from September 2016 to March 2021 was conducted. Demographics, etiology of hydrocephalus, operative details, electroencephalography (EEG) data, MRI findings, need for subsequent procedures, perioperative laboratory tests, medical history, and presence of clinical postoperative seizures were collected. Postoperative seizures were defined as clinical seizures within 24 hours of surgery. Eighteen patients received levetiracetam intraoperatively as well as over the next 7 days postoperatively for seizure prophylaxis. RESULTS Of 37 included patients, 9 (24%) developed clinical seizures within 24 hours after surgery, 5 of whom subsequently had electroclinical seizures captured on video-EEG. The clinical seizures in 4 of those 5 patients (80%) may have been associated with the hemisphere of the brain through which the endoscope was introduced. The median corrected age of the cohort was 3.4 months. The median corrected age of patients who did not develop postoperative seizures was 2.3 months compared with 0.7 months for patients who did develop postoperative seizures (p > 0.99). Postoperative seizures occurred in 43% (3/7) of prenatally repaired myelomeningocele patients versus 29% (2/7) of postnatally repaired myelomeningocele patients. Of the 18 patients who received prophylactic levetiracetam, none (0%) developed postoperative seizures compared with 9 of the 19 patients (47%) who did not receive prophylactic levetiracetam (p = 0.014). CONCLUSIONS Postoperative seizures were recorded in 24% of the pediatric patients who underwent ETV/CPC for hydrocephalus, which is higher than previously reported rates in the literature of 5%. Since 80% of the postoperative electrographic seizures may have been associated with the hemisphere through which the endoscope was introduced, the surgical entry site may contribute to postoperative seizure development. In patients who received prophylactic perioperative levetiracetam, the postoperative seizure incidence dropped to 0% compared with 47% in those who did not receive prophylactic perioperative levetiracetam. This finding indicates that the use of prophylactic perioperative levetiracetam may be efficacious in the prevention of clinical seizures in this patient population.

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Efficacy and safety of flexible versus rigid endoscopic third ventriculostomy in pediatric and adult populations: a systematic review and meta-analysis

Neurosurgical Review ◽

10.1007/s10143-021-01590-6 ◽

2021 ◽

Author(s):

Alessandro Boaro ◽

Bhargavi Mahadik ◽

Anthony Petrillo ◽

Francesca Siddi ◽

Sharmila Devi ◽

...

Keyword(s):

Endoscopic Third Ventriculostomy ◽

Perioperative Complications ◽

Meta Analysis ◽

Case Series ◽

Optimal Choice ◽

Third Ventriculostomy ◽

Efficacy And Safety ◽

Bleeding Events ◽

Random Effects Models ◽

Hydrocephalus Treatment

AbstractEndoscopic third ventriculostomy (ETV) is a well-established surgical procedure for hydrocephalus treatment, but there is sparse evidence on the optimal choice between flexible and rigid approaches. A meta-analysis was conducted to compare efficacy and safety profiles of both techniques in pediatrics and adults. A comprehensive search was conducted on PubMED, EMBASE, and Cochrane until 11/10/2019. Efficacy was evaluated comparing incidence of ETV failure, while safety was defined by the incidence of perioperative complications, intraoperative bleedings, and deaths. Random-effects models were used to pool the incidence. Out of 1365 studies, 46 case series were meta-analyzed, yielding 821 patients who underwent flexible ETV and 2918 who underwent rigid ETV, with an age range of [5 days–87 years]. Although flexible ETV had a higher incidence of failure in adults (flexible: 54%, 95%CI: 22–82% vs rigid: 20%, 95%CI: 22–82%) possibly due to confounding due to etiology in adults treated with flexible, a smaller difference was seen in pediatrics (flexible: 36%, pediatric: 32%). Safety profiles were acceptable for both techniques, with a certain degree of variability for complications (flexible 2%, rigid 18%) and death (flexible 1%, rigid 3%) in pediatrics as well as complications (rigid 9%, flexible 13%), death (flexible 4%, rigid 6%) and intra-operative bleeding events (rigid 6%, flexible 8%) in adults. No clear superiority in efficacy could be depicted between flexible and rigid ETV for hydrocephalus treatment. Safety profiles varied by age but were acceptable for both techniques. Well-designed comparative studies are needed to assess the optimal endoscopic treatment option for hydrocephalus.

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Opening and closure of intraventricular neuroendoscopic procedures in infants under 1 year of age: institutional technique, case series and review of the literature

Child s Nervous System ◽

10.1007/s00381-020-04895-x ◽

2020 ◽

Vol 37 (1) ◽

pp. 101-105 ◽

Cited By ~ 1

Author(s):

M. D. Cearns ◽

M. Kommer ◽

A. Amato-Watkins ◽

E. Campbell ◽

T. Beez ◽

...

Keyword(s):

Endoscopic Third Ventriculostomy ◽

Case Series ◽

Csf Leak ◽

Third Ventriculostomy ◽

Retrospective Case ◽

Infantile Hydrocephalus ◽

Wound Breakdown ◽

Csf Leakage ◽

Clinical Records

Abstract Purpose Intraventricular neuroendoscopic techniques, particularly third ventriculostomy, are employed increasingly in the management of infantile hydrocephalus. However, surgical access to the ventricular cavities is associated with a risk of post-operative cerebrospinal fluid (CSF) leak. Here, we describe a structured, multi-layered approach to wound opening and closure which aims to maximise the natural tissue barriers against CSF leakage. We present a series of patients undergoing this technique and subsequently review the literature regarding opening and closure techniques in paediatric intraventricular neuroendoscopic procedures. Methods We performed a retrospective case series analysis of patients under 1 year of age who underwent intraventricular neuroendoscopic procedures in a single institution over a 5-year period. Patients were identified from an institutional operative database, and operation notes and clinical records were subsequently reviewed. Results 28 patients fulfilled the inclusion criteria for this study. The mean age at operation was 9 weeks. 27 patients underwent endoscopic third ventriculostomy whilst 1 underwent endoscopic septostomy, and all patients underwent our structured, multi-layered opening and closure technique. Follow-up ranged from 4 months to 5 years. There were no cases of post-operative CSF leak, infection or wound breakdown. 12 patients remained shunt-free at the last follow-up, with the remaining 16 requiring shunt insertion for progressive hydrocephalus at a mean of 24 days post-operatively. Conclusion Various methods aiming to prevent post-operative CSF leak have been reported in the literature. We propose that our institutional technique may be of benefit in minimising this risk in infants undergoing endoscopic third ventriculostomy and similar intraventricular neuroendoscopic procedures.

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Complications and subsequent removal of retained shunt hardware after endoscopic third ventriculostomy: case series

Journal of Neurosurgery Pediatrics ◽

10.3171/2013.3.peds12489 ◽

2013 ◽

Vol 11 (6) ◽

pp. 722-726 ◽

Cited By ~ 8

Author(s):

Jonathan Pindrik ◽

George I. Jallo ◽

Edward S. Ahn

Keyword(s):

Endoscopic Third Ventriculostomy ◽

Case Series ◽

Wound Dehiscence ◽

Third Ventriculostomy ◽

Subsequent Removal ◽

Shunt System ◽

Shunt Valve ◽

Shunt Insertion ◽

History Of ◽

Shunt Removal

This case series highlights multiple complications and subsequent removal of retained shunt hardware in pediatric patients after successful endoscopic third ventriculostomy (ETV). Removal or retention of existing shunt hardware following ETV represents an important dilemma. Prior studies have reported infections and organ perforation related to nonfunctioning shunts but none in the context of successful ETV. Data obtained in 3 children with hydrocephalus treated at the authors' institution were retrospectively reviewed after the patients experienced complications due to retained shunt hardware following ETV. Etiologies of hydrocephalus included tectal glioma and intraventricular hemorrhage. All 3 patients had a history of multiple shunt revisions and underwent urgent ETV in the setting of a shunt malfunction. In each case, the entire shunt system was left in situ, but it became the source of subsequent complications. Two of the 3 patients presented with the shunt infected by gram-negative bacilli 10 days and 4.5 months postoperatively, respectively. The remaining patient experienced wound dehiscence over the shunt valve 4.5 months after ETV. In all patients, the complications were managed successfully by removing the shunt hardware. None of the patients required repeat shunt insertion from the time of removal throughout the follow-up period (mean 24 months, range 9–36 months). During the study period, a total of 6 patients with indwelling shunt hardware underwent ETV with the expectation of being shunt independent. Among these 6 patients, 3 experienced no complications from the retained hardware whereas 3 patients (50%) ultimately experienced adverse consequences related to retained hardware. This case series illustrates complications involving retained shunt hardware after successful ETV. These examples support consideration of shunt removal at the time of ETV in the appropriate context.

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Airway Adventures of Airtraq: Use of Airtraq Optical Laryngoscope with Adaptor in Infants with Obstructive Hydrocephalus Posted for Endoscopic Third Ventriculostomy

Journal of Neuroanaesthesiology and Critical Care ◽

10.1055/s-0040-1701800 ◽

2020 ◽

Author(s):

Shahna Ali ◽

Hassan Rashid ◽

Obaid A. Siddiqui ◽

Manazir Athar

Keyword(s):

Endoscopic Third Ventriculostomy ◽

Low Cost ◽

Obstructive Hydrocephalus ◽

Case Series ◽

Ease Of Use ◽

Third Ventriculostomy ◽

Pediatric Airway ◽

Precise Knowledge ◽

Successful Approach ◽

Single Use

AbstractThe pediatric airway is a challenge for the anesthetist due to difficulty in adequate assessment, scarcity of management algorithms, lack of precise knowledge regarding incidence, as well as limitations of the various devices, instruments, and video laryngoscopes. We present a case series of infants with obstructive Hydrocephalus with anticipated difficult intubation posted for endoscopic third ventriculostomy (ETV) in whom the airway was successfully secured using Airtraq optical laryngoscope with adaptor. Although this device has not been widely studied in pediatrics age group, there are different sizes available for use among children. The ease of use, short learning curve, low cost, single use, and successful approach to difficult airway have made it to being the main rescue technique when the initial approach has failed.

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