A Novel Approach of Navigation-Assisted Flexible Neuroendoscopy

2017 ◽  
Vol 14 (3) ◽  
pp. E33-E37 ◽  
Author(s):  
Jaime G Torres-Corzo ◽  
Leonardo Rangel-Castilla ◽  
Mario Alberto Islas-Aguilar ◽  
Roberto Rodríguez-Della Vecchia
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Clinical Presentation ◽  
Flexible Endoscope ◽  
Cerebral Aqueduct ◽  
Third Ventriculostomy ◽  
Rigid Endoscopy ◽  
Novel Approach ◽  
Major Disadvantage ◽  
Electromagnetic Neuronavigation ◽  
Severe Hydrocephalus

Abstract BACKGROUND AND IMPORTANCE Neuronavigation-assisted endoscopy is commonly used for skull base and intraventricular surgery. Flexible neuroendoscopy offers certain advantages over rigid endoscopy; however, a major disadvantage of the flexible endoscope has been easy disorientation in the flexed position. Neuronavigation-assisted flexible neuroendoscopy was not available until now. This is the first report of the use of navigation-assisted flexible neuroendoscopy in a patient with hydrocephalus. CLINICAL PRESENTATION A 10-mo-old girl presented with irritability and vomiting to the emergency department and was found to have severe hydrocephalus. The patient underwent successful endoscopic third ventriculostomy and exploration of the ventricles (lateral, third, cerebral aqueduct, fourth) and basal cisterns with the flexible neuroendoscopy assisted with electromagnetic neuronavigation. CONCLUSION As demonstrated by this initial experience, neuronavigation-assisted flexible neuroendoscopy is a feasible and safe tool, endoscopic procedures with the flexible endoscope may be possible in a safer manner. We report the first use of neuronavigation-assisted flexible neuroendoscopy to perform an ETV and exploration of the entire ventricular system. Further evaluation will be necessary to define and expand its applications in neurosurgery.

Rigid versus flexible neuroendoscopy: a systematic review and meta-analysis of endoscopic third ventriculostomy for the management of pediatric hydrocephalus

2021 ◽  
pp. 1-11
Author(s):  
Daphne Li ◽  
Vijay M. Ravindra ◽  
Sandi K. Lam
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Statistical Significance ◽  
Flexible Endoscopy ◽  
Third Ventriculostomy ◽  
Complication Rates ◽  
Inclusion Criteria ◽  
Related Complication ◽  
Rigid Endoscopy ◽  
Pediatric Hydrocephalus ◽  
Significant Difference

OBJECTIVE Endoscopic third ventriculostomy (ETV), with or without choroid plexus cauterization (±CPC), is a technique used for the treatment of pediatric hydrocephalus. Rigid or flexible neuroendoscopy can be used, but few studies directly compare the two techniques. Here, the authors sought to compare these methods in treating pediatric hydrocephalus. METHODS A systematic MEDLINE search was conducted using combinations of keywords: “flexible,” “rigid,” “endoscope/endoscopic,” “ETV,” and “hydrocephalus.” Inclusion criteria were as follows: English-language studies with patients 2 years of age and younger who had undergone ETV±CPC using rigid or flexible endoscopy for hydrocephalus. The primary outcome was ETV success (i.e., without the need for further CSF diversion procedures). Secondary outcomes included ETV-related and other complications. Statistical significance was determined via independent t-tests and Mood’s median tests. RESULTS Forty-eight articles met the study inclusion criteria: 37 involving rigid endoscopy, 10 involving flexible endoscopy, and 1 propensity scored–matched comparison. A cumulative 560 patients had undergone 578 rigid ETV±CPC, and 661 patients had undergone 672 flexible ETV±CPC. The flexible endoscopy cohort had a significantly lower average age at the time of the procedure (0.33 vs 0.53 years, p = 0.001) and a lower preoperatively predicted ETV success score (median 40, IQR 32.5–57.5 vs 62.5, IQR 50–70; p = 0.033). Average ETV success rates in the rigid versus flexible groups were 54.98% and 59.65% (p = 0.63), respectively. ETV-related complication rates did not differ significantly at 0.63% for flexible endoscopy and 3.46% for rigid endoscopy (p = 0.30). There was no significant difference in ETV success or complication rate in comparing ETV, ETV+CPC, and ETV with other concurrent procedures. CONCLUSIONS Despite the lower expected ETV success scores for patients treated with flexible endoscopy, the authors found similar ETV success and complication rates for ETV±CPC with flexible versus rigid endoscopy, as reported in the literature. Further direct comparison between the techniques is necessary.

Establishing successful cerebrospinal fluid flow for radioimmunotherapy

2012 ◽  
Vol 9 (3) ◽  
pp. 316-319 ◽  
Author(s):  
Kim Kramer ◽  
Heather J. McCrea ◽  
Cheryl Fischer ◽  
Jeffrey P. Greenfield
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Imaging Study ◽  
Cerebral Aqueduct ◽  
Third Ventriculostomy ◽  
Intraventricular Administration ◽  
Csf Flow ◽  
Opening Pressure ◽  
Cerebrospinal Fluid Flow ◽  
Cine Mr ◽  
Flow Through

Successful delivery of intraventricular radioimmunotherapy is contingent on adequate CSF flow. The authors present a patient with medulloblastoma in whom obstructed CSF flow was causing hydrocephalus, which was initially corrected by implantation of a programmable shunting device. While managing the hydrocephalus, an endoscopic third ventriculostomy (ETV) needed to be performed in a collapsed ventricular system to ensure adequate radioimmunotherapy distribution. This 18-month-old patient with medulloblastoma involving leptomeningeal dissemination presented for intraventricular radioimmunotherapy. A CSF 111In-DTPA scintigraphy study obtained through the existing programmable ventriculoperitoneal shunt demonstrated activity in the lateral and third ventricles, but no activity over the cerebral convexities or spinal canal, consistent with obstruction at the level of the cerebral aqueduct. By maximization of ventricular size in a controlled setting, the patient was able to undergo a trial of ETV through very small ventricles. A postoperative CINE MR imaging study confirmed patent ETV. The pressure settings on the shunt were kept at the highest opening pressure (200 mm H2O) to maximize flow through the stoma and improve the distribution of CSF throughout the subarachnoid space. The CSF flow scintigraphy study was again performed, this time with tracer activity demonstrated down the thecal sac at 3 hours, and symmetrically over the cerebral convexities at 24 hours. The patient began weekly intraventricular administration of 131I-3F8 therapy. Successful rerouting of CSF flow for the purpose of therapeutic radioisotope administration is possible. Endoscopic third ventriculostomy can be considered in patients with programmable shunting devices; normal or slit ventricles do not preclude successful ETV.

scholarly journals Unusual complication of ventriculoperitoneal shunt

2013 ◽  
Vol 20 (4) ◽  
pp. 375-378 ◽  
Author(s):  
Omotayo A. Ojo ◽  
Olumide Elebute ◽  
Okezie O. Kanu ◽  
Olusegun Adebisi Popoola
Keyword(s):  
Foreign Body ◽  
Conventional Method ◽  
Ventriculoperitoneal Shunt ◽  
Rare Case ◽  
Endoscopic Third Ventriculostomy ◽  
Shunt Infection ◽  
Third Ventriculostomy ◽  
Unusual Complication ◽  
Major Disadvantage ◽  
Shunt Migration

Abstract Ventriculoperitoneal shunt (VPS) is the conventional method of managing hydrocephalus until recently that endoscopic third ventriculostomy is becoming popular. The major disadvantage of VPS is the fact that it constitutes a foreign body and prone to complications such as mechanical blockage, shunt infection, shunt migration and rarely shunt protrusion. Shunt extrusion through the vagina and anus are rare but have been documented. We present a rare case of shunt migrating through the external inguinal ring into the scrotal sac in a patient.

Endoscopic third ventriculostomy and choroid plexus cauterization in posthemorrhagic hydrocephalus of prematurity

2014 ◽  
Vol 13 (4) ◽  
pp. 433-439 ◽  
Author(s):  
Parthasarathi Chamiraju ◽  
Sanjiv Bhatia ◽  
David I. Sandberg ◽  
John Ragheb
Keyword(s):  
Success Rate ◽  
Patient Outcomes ◽  
Premature Infants ◽  
Gestational Age ◽  
Endoscopic Third Ventriculostomy ◽  
Cerebral Aqueduct ◽  
Third Ventriculostomy ◽  
Posthemorrhagic Hydrocephalus ◽  
Prepontine Cistern ◽  
Choroid Plexus Cauterization

Object The aim of this study was to determine the role of endoscopic third ventriculostomy and choroid plexus cauterization (ETV/CPC) in the management of posthemorrhagic hydrocephalus of prematurity (PHHP) and to analyze which factors affect patient outcomes. Methods This study retrospectively reviewed medical records of 27 premature infants with intraventricular hemorrhage (IVH) and hydrocephalus treated with ETV and CPC from 2008 to 2011. All patients were evaluated using MRI before the procedure to verify the anatomical feasibility of ETV/CPC. Endoscopic treatment included third ventriculostomy, septostomy, and bilateral CPC. After ETV/CPC, all patients underwent follow-up for a period of 6–40 months (mean 16.2 months). The procedure was considered a failure if the patient subsequently required a shunt. The following factors were analyzed to determine a relationship to patient outcomes: gestational age at birth, corrected age and weight at surgery, timing of surgery after birth, grade of IVH, the status of the prepontine cistern and cerebral aqueduct on MRI, need for a ventricular access device prior to the endoscopic procedure, and scarring of the prepontine cistern noted at surgery. Results Seventeen (63%) of 27 patients required a shunt after ETV/CPC, and 10 patients did not require further CSF diversion. Several factors studied were associated with a higher rate of ETV/CPC failure: Grade IV hemorrhage, weight 3 kg or less and age younger than 3 months at the time of surgery, need for reservoir placement, and presence of a normal cerebral aqueduct. Two factors were found to be statistically significant: the patient's corrected gestational age of less than 0 weeks at surgery and a narrow prepontine cistern on MRI. The majority (83%) of ETV/CPC failures occurred in the first 3 months after the procedure. None of the patients had a complication directly related to the procedure. Conclusions Endoscopic third ventriculostomy/CPC is a safe initial procedure for hydrocephalus in premature infants with IVH and hydrocephalus, obviating the need for a shunt in selected patients. Even though the success rate is low (37%), the lower rate of complications in comparison with shunt treatment may justify this procedure in the initial management of hydrocephalus. As several of the studied factors have shown influence on the outcome, patient selection based on these observations might increase the success rate.

Intraoperative assessment of cerebral aqueduct patency and cisternal scarring: impact on success of endoscopic third ventriculostomy in 403 African children

2010 ◽  
Vol 5 (2) ◽  
pp. 204-209 ◽  
Author(s):  
Benjamin C. Warf ◽  
Abhaya V. Kulkarni
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Proportional Hazards ◽  
Test Validity ◽  
Preoperative Imaging ◽  
Cerebral Aqueduct ◽  
Third Ventriculostomy ◽  
Initial Operation ◽  
Survival Curves ◽  
Prepontine Cistern ◽  
Shunt Placement

Object In the setting of a developing country where preoperative imaging may be limited, the authors wished to determine whether cisternal scarring or aqueduct patency at the time of surgery was sufficiently predictive of the failure of endoscopic third ventriculostomy (ETV) to justify shunt placement at the time of the initial operation. Methods The status of the prepontine cistern and aqueduct at the time of ventriculoscopy was prospectively recorded in 403 children in whom an ETV had been completed. Kaplan-Meier methods were used to construct survival curves. A Cox proportional hazards model was used to provide estimates of HRs for the time to ETV failure. Several independent variables were tested in a single multivariable model, including those previously shown to be associated with ETV survival, that is, age, hydrocephalus etiology, and extent of choroid plexus cauterization (CPC). In addition, intraoperative variables of particular interest were included in the analysis: status of the aqueduct at surgery (closed vs open) and status of the prepontine cistern at surgery (scarred vs clean/unscarred). Multicollinearity was not a concern since the variance inflation factors for all variables were < 2. The examination of stratified survival curves confirmed the appropriateness of the proportional hazards assumption for each variable. Results Overall actuarial 3-year success was 57%. Consistent with previous results, age, hydrocephalus etiology, and extent of CPC were significantly associated with ETV success. A closed aqueduct and an unscarred cistern were each independently associated with significantly better ETV success (HRs of 0.66 and 0.44, respectively). The presence of cisternal scarring more than doubled the risk of ETV failure, and an open aqueduct increased the risk of failure by 50%. Conclusions Intraoperative observations of the aqueduct and prepontine cistern are independent predictors of the risk of ETV failure and can be used to further refine outcome predictions based on age, hydrocephalus etiology, and extent of CPC. Further studies will test validity in several African centers and determine what threshold of failure risk should prompt shunt placement at the initial operation.

Complications of Endoscopic Third Ventriculostomy in Previously Shunted Patients

2008 ◽  
Vol 63 (suppl_1) ◽  
pp. ONS168-ONS175 ◽  
Author(s):  
Walter J. Hader ◽  
Robin L. Walker ◽  
S. Terence Myles ◽  
Mark Hamilton
Keyword(s):  
Effective Treatment ◽  
Endoscopic Third Ventriculostomy ◽  
Clinical Presentation ◽  
Obstructive Hydrocephalus ◽  
Shunt Malfunction ◽  
Third Ventriculostomy ◽  
Newly Diagnosed ◽  
History Of ◽  
Additional Procedure

Abstract Objective: Endoscopic third ventriculostomy (ETV) is considered to be a safe and effective treatment in selected patients as an initial treatment for obstructive hydrocephalus and at the time of shunt malfunction in previously shunted patients. We compared the outcome and complications of ETV between patients with newly diagnosed hydrocephalus and those with previous shunting procedures. Methods: A retrospective review of patients undergoing ETV from 1996 to 2004 at Alberta's Childrens Hospital and Foothills Medical Centre was completed. Patient data included symptoms at clinical presentation, cause of hydrocephalus, age at initial shunt, number of previous shunt revisions, age at ETV, complications, and subsequent shunting procedures performed. Results: A total of 131 patients were identified with a minimum follow-up duration of 1 year; 71 (82.5%) of 86 patients who underwent ETV as a primary procedure and 36 (80%) of 45 patients who had ETV at the time of shunt malfunction were shunt-free at the last follow-up evaluation. Patients younger than 1 year old who underwent ETV were more likely to require an additional procedure for control of their hydrocephalus (P&lt; 0.01). Serious complications after ETV occurred more frequently in patients who presented at the time of shunt malfunction (14 of 45 patients, 31%) compared with patients who underwent primary ETV (seven of 86 patients, 8%) (P = 0.02). Previously shunted patients with a history of two or more revisions (P= 0.03) and who experienced a serious complication at the time of ETV (P = 0.01) were more likely to require shunt replacement. Conclusion: ETV is an effective treatment both in selected patients with newly diagnosed hydrocephalus and in patients with a previous shunting procedure who are presenting with malfunction. Complications of ETV occur more frequently in previously shunted patients than in patients treated for newly diagnosed hydrocephalus, and care must be taken in the selection and treatment of these patients.

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