Endoscopic Third Ventriculostomy in 250 Adults With Hydrocephalus

Neurosurgery ◽  
2015 ◽  
Vol 78 (1) ◽  
pp. 109-119 ◽  
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.

Delayed Stoma Failure in Adult Communicating Hydrocephalus After Initial Successful Treatment by Endoscopic Third Ventriculostomy

Neurosurgery ◽  
2010 ◽  
Vol 66 (6) ◽  
pp. E1210-E1211 ◽  
Author(s):  
Andrew J. Fabiano ◽  
Kristina Doyle ◽  
Walter Grand
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Endoscopic Third Ventriculostomy ◽  
Brain Magnetic Resonance Imaging ◽  
Normal Pressure ◽  
Symptom Improvement ◽  
Third Ventriculostomy ◽  
Communicating Hydrocephalus ◽  
Stoma Closure ◽  
Ventricular Dilation ◽  
Memory Problems

Abstract OBJECTIVE To describe 2 cases of delayed endoscopic third ventriculostomy (ETV) failure in 2 adult patients initially successfully treated for normal pressure hydrocephalus by ETV. The cause of ETV failure was stoma closure, and this was documented in both instances by direct endoscopic inspection. CLINICAL PRESENTATION In the first case, a 67-year-old woman presented with progressive gait disturbance, incontinence, and memory problems. Brain magnetic resonance imaging exhibited ventricular dilation, including the fourth ventricle, disproportionate to cortical atrophy. In the second case, a 55-year-old man presented with progressive gait disturbance, urinary incontinence, memory problems, and headaches. Brain magnetic resonance imaging exhibited communicating hydrocephalus. INTERVENTION The first patient underwent an ETV with subsequent improvement in all symptom areas. Three years and 2 months later, she experienced a return of original symptoms and ventricular dilation on brain computed tomography, compared with previous postoperative scans. Direct endoscopic inspection of the third ventricular floor revealed stoma closure secondary to fibrotic scar. The patient subsequently underwent ventriculoperitoneal shunt placement that resulted in symptom improvement. The patient in the second case underwent an ETV that resulted in marked symptom improvement in all areas. Four years and 3 months later, he experienced a return of gait difficulties and headaches. Direct endoscopic inspection showed a lack of cerebrospinal fluid pulsations through the third ventricular stoma and dense arachnoid adhesions around the basilar artery. A repeat ETV was unsuccessful. Subsequent ventriculoperitoneal shunt placement resulted in symptom improvement. CONCLUSION ETV may provide an effective treatment for patients with normal pressure hydrocephalus, a form of communicating hydrocephalus. Stoma closure can be a mechanism of delayed ETV failure in normal pressure hydrocephalus, consistent with reports of ETV failure in pediatric obstructive hydrocephalus.

Endoscopic third ventriculostomy in the management of communicating hydrocephalus: a preliminary study

2008 ◽  
Vol 109 (5) ◽  
pp. 923-930 ◽  
Author(s):  
Feng Hailong ◽  
Huang Guangfu ◽  
Tan Haibin ◽  
Pu Hong ◽  
Cheng Yong ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Mental State ◽  
Endoscopic Third Ventriculostomy ◽  
Normal Pressure ◽  
Third Ventriculostomy ◽  
Communicating Hydrocephalus ◽  
Favorable Result ◽  
Multivariate Statistical ◽  
Cerebrospinal Fluid Flow ◽  
Cine Mr

Object The purpose of this study was to elucidate the efficacy of endoscopic third ventriculostomy (ETV), the procedure's indications, and prognosis after treatment in patients with communicating hydrocephalus. Methods Between August 2002 and January 2007, 32 ETVs were performed in 32 patients with communicating hydrocephalus (24 men and 8 women) at the authors' institution. The patients ranged in age from 25 to 82 years old (mean 61.4 years), and had a follow-up of 2–53 months (mean 14 months). The patients were divided into 2 groups according to the results of preoperative tests. The first group included 17 patients with idiopathic normal-pressure hydrocephalus, and the second group included 15 patients with secondary communicating hydrocephalus who experienced meningitis, spontaneous subarachnoid hemorrhage, or hypertensive intracranial hemorrhage. Both univariate and multivariate statistical analyses were performed to assess the prognostic relevance of the cause of communicating hydrocephalus, the preoperative Kiefer scale score, and hydrodynamic findings in predicting the results after ETV. Results Excellent results were achieved in 25% of patients, good results in 40.6%, satisfactory in 12.5%, and poor in 21.9% of patients. The authors found that the preoperative Kiefer score and the patient's age had a high correlation with overall ETV outcome. Nineteen patients (59.3%) with comparatively mild symptoms (Kiefer Score 0–10) had a favorable course after ETV. Three patients in this group showed a satisfactory course, and 1 had a poor course. Among patients with Kiefer scores of 11–21 points, 6 (46%) had a favorable course, 1 (8%) a satisfactory one, and 6 (46%) had no relief from symptoms at all. Fourteen (88%) of 16 patients < 65 years of age had a favorable course after ETV. However, only 7 of 16 patients (44%) > 65 years showed definite improvement after ETV. Among the Kiefer score indicators, the preoperative mental state played an important role in predicting ETV outcome. The results of this test imply that the relative risk of ETV failure in a patient with a concentration disorder is about 2 times that in a patient without. Of the 7 patients with secondary communicating hydrocephalus who had elevated intracranial pressure (range 205–265 mm H2O), 5 patients had a favorable result from ETV. Meanwhile, in the same group, 5 (63%) of 8 patients with normal intracranial pressure had an excellent or good result. In comparing the findings on cine MR imaging before and after surgery, there was evidence of a decrease in the velocity and quantity of cerebrospinal fluid flow in the aqueduct after ETV. Conclusions The new hydrodynamic concept of hydrocephalus opens the possibility that ETV may be an effective treatment for communicating hydrocephalus. It thus constitutes an interchangeable alternative to shunting. Patient age, analysis of the causes of hydrocephalus, and mental state evaluation play important roles in outcome prediction in patients with communicating hydrocephalus who undergo ETV. Randomized clinical studies are needed to explore further the role of this treatment in communicating hydrocephalus therapy.

scholarly journals Intraventricular pressure in non-communicating hydrocephalus patients before endoscopic third ventriculostomy

Open Medicine ◽  
2019 ◽  
Vol 14 (1) ◽  
pp. 909-912
Author(s):  
Werner Tiefenthaler ◽  
Johannes Burtscher ◽  
Patrizia L. Moser ◽  
Ingo H. Lorenz ◽  
Christian Kolbitsch
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Third Ventriculostomy ◽  
Communicating Hydrocephalus ◽  
Intraventricular Pressure ◽  
Positive End Expiratory Pressure

AbstractBackgroundIn patients with non-communicating hydrocephalus impairment of cerebral compliance can occur pre- but also intraoperatively.MethodologyIn such patients (n = 6) undergoing endoscopic third ventriculostomy (ETV), the present study aimed to investigate the effect of ETCO2 (e.g 40 mmHg and 60 mmHg) and positive end-expiratory pressure (PEEP) (e.g. 6 cm and 12 cm H2O) on intraventricular pressure (IVP).FindingsBefore but not after ETV, hypercapnia in contrast to PEEP increased IVP(before ETV(PEEP-6/ ETCO2-40: 2.6 ± 2.4 mmHg) vs. (PEEP-6/ ETCO2-60: 12 ± 6.4 mmHg*); (PEEP-12/ ETCO2-40: 4.2 ± 4.1 mmHg) vs. (PEEP-12/ ETCO2-60: 13.7 ± 7.6 mmHg*), * significant, P ≤ 0.05;after ETV(PEEP-6/ ETCO2-40: 2.0 ± 1.2 mmHg) vs. (PEEP-6/ ETCO2-60: 4.4 ± 3.1 mmHg); (PEEP-12/ ETCO2-40: 1.6 ± 1.3 mmHg) vs. (PEEP-12/ ETCO2-60: 6.6 ± 2.6 mmHg), * significant, P ≤ 0.05).ConclusionPatients with non-communicating hydrocephalus showed that hypercapnia but not PEEP increases significantly IVP before but not after ETV.

Brain Tectal Tumors: A Flexible Approach

2018 ◽  
Vol 16 (3) ◽  
pp. E95-E100
Author(s):  
Alessandro Perin ◽  
Tommaso Francesco Galbiati ◽  
Cecilia Casali ◽  
Federico Giuseppe Legnani ◽  
Luca Mattei ◽  
...  
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Good Prognosis ◽  
Endoscopic Biopsy ◽  
Third Ventriculostomy ◽  
Histopathological Diagnosis ◽  
Cerebrospinal Fluid Diversion ◽  
Oncological Patients ◽  
Slow Progression ◽  
Benign Histology ◽  
Midbrain Tumors

Abstract BACKGROUND AND IMPORTANCE Mesencephalic tectal gliomas represent a subset of midbrain tumors, which are more frequent in children than in adults. They usually become symptomatic when causing hydrocephalus by occluding the aqueduct. Because of their slow progression, due to their benign histology, they are characterized by a relatively good prognosis, although hydrocephalus might jeopardize patients’ prognosis. Treatment is usually represented by cerebrospinal fluid diversion associated or not with biopsy. CLINICAL PRESENTATION We report 2 illustrative cases of tectal gliomas in adults where endoscopic third ventriculostomy (ETV) and simultaneous endoscopic biopsy were obtained during the same operation by means of a single burr hole with a flexible endoscope. CONCLUSION We recommend using this overlooked neurosurgical tool for such cases, since it allows the surgeon to safely perform an ETV, then judge whether biopsy can be done or not, without harming the patient, and possibly achieving an important piece of information (histopathological diagnosis) to manage this subset of oncological patients.

ENDOSCOPIC THIRD VENTRICULOSTOMY (ETV) IS A BETTER ALTERNATIVE FOR VP SHUNT FAILURE IN NON-COMMUNICATING HYDROCEPHALUS

2021 ◽  
pp. 65-67
Author(s):  
Ramesh Tanger ◽  
Dinesh Kumar Barolia ◽  
Arka Chatterjee ◽  
Punit Singh Parihar ◽  
Arun Gupta
Keyword(s):  
Success Rate ◽  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
Shunt Revision ◽  
Third Ventriculostomy ◽  
Communicating Hydrocephalus ◽  
Shunt Failure ◽  
Shunt Insertion ◽  
Vp Shunt

CONTEXT: VP Shunt is most commonly used procedure for hydrocephalus but shunt failure is also the common complication in many patients. Endoscopic third ventriculostomy (ETV) is an accepted procedure for the treatment of obstructive hydrocephalus. The aim of our study is to evaluate the success rate AIM AND OBJECTIVE - of ETV in patients of obstructive hydrocephalus formerly treated by ventriculo-peritoneal (VP shunt) shunt. The failure VP shunt was removed before ETV. MATERIALS AND METHOD: This study was conducted between June 2015 and December 2019 in single unit of our department. Twenty one (n=21) patients were enrolled for this study. All patients were admitted with failure of VP shunt. They were known case of non-communicating hydrocephalus previously operated for VP shunt. Six patients were excluded for ETV because CT/MRI show grossly distorted anatomy of ventricles. Endoscopic third ventriculostomy was attempted in 15 patients, but ventriculostomy was done successfully in 10 patients, rests were treated with revision of VP shunt. All patients in this study were radiologically diagnosed RESULTS: case of hydrocephalus due to aqueduct stenosis. They were experienced VP shunt insertion but there were failure of shunt due to any reason. ETV procedures were done successfully in 10 patients. Out of 10 patients one patient needed shunt insertion due ineffective ETV. Shunt revision was done in 11 patients. There was no serious complication during and after ETV procedures. The follow-up period of patients with successful ETV was 6–60 months. This follow-up was uneventful and peaceful for their parents. ETV can be considered as an alternative treatment for the patients w CONCLUSION: ith VP shunt failure with an acceptable success rate of 80%, although long-term follow-up is needed for these patients.

scholarly journals The 50 most cited publications in endoscopic third ventriculostomy: a bibliometric analysis

2019 ◽  
Vol 23 (2) ◽  
pp. 145-152 ◽  
Author(s):  
Nirmeen Zagzoog ◽  
Ahmed Attar ◽  
Kesh Reddy
Keyword(s):  
Bibliometric Analysis ◽  
Endoscopic Third Ventriculostomy ◽  
Present Report ◽  
Obstructive Hydrocephalus ◽  
Current Status ◽  
Third Ventriculostomy ◽  
Communicating Hydrocephalus ◽  
Publish Or Perish ◽  
Pediatric Age Group ◽  
Current Century

OBJECTIVEAlthough endoscopic third ventriculostomy (ETV) for the treatment of hydrocephalus was introduced in 1923, the method was relegated to the sidelines in favor of extracranial techniques. Since the 1990s to the beginning of the current century, however, ETV has undergone a remarkable resurgence to become the first-line treatment for obstructive hydrocephalus, and for some groups, the procedure has been applied for communicating hydrocephalus as well. In the present study, the authors identified the top 50 cited ETV works. These articles represent works of significance that document current practices and provide guidance for future inquiry.METHODSThe top 50 cited articles pertaining to ETV were identified using bibliometric data obtained with the Harzing’s Publish or Perish software search engine. These high-impact works were evaluated for publication properties including year, country of authorship, category, and journal.RESULTSThe top 50 works were cited an average of 141.02 times with a mean of 9.45 citations per year. Articles published in 2005 were the most numerous in the top 50 group. These top articles were most frequently published in the Journal of Neurosurgery: Pediatrics. Most of the articles were clinical studies reporting on patients in the pediatric age group. The country of most authorship was the US, although many other countries were among the top 50 works.CONCLUSIONSThe present report discusses the bibliometric analysis of the top 50 ETV articles. This list may be useful to those interested in the progress and current status of this procedure.

scholarly journals The comparative effectiveness of ventricular shunt placement versus endoscopic third ventriculostomy for initial treatment of hydrocephalus in infants

2014 ◽  
Vol 13 (3) ◽  
pp. 295-300 ◽  
Author(s):  
Sarah C. Jernigan ◽  
Jay G. Berry ◽  
Dionne A. Graham ◽  
Liliana Goumnerova
Keyword(s):  
Intraventricular Hemorrhage ◽  
Endoscopic Third Ventriculostomy ◽  
Hierarchical Regression ◽  
Third Ventriculostomy ◽  
Failure Rates ◽  
Shunt Placement ◽  
Patient Demographics ◽  
Initial Surgery ◽  
Surgical Failure ◽  
Csf Diversion

Object The purpose of this study was to compare the effectiveness of CSF diversion with endoscopic third ventriculostomy (ETV) versus shunt therapy in infants with hydrocephalus. Methods The authors conducted a retrospective analysis of 5416 infants 1 year of age or younger with hydrocephalus (congenital or acquired) in whom CSF diversion was performed using either ETV or shunt placement at 41 children's hospitals between 2004 and 2009. Data were obtained from the Pediatric Health Information Systems database. Surgical failure was defined as the need for a repeat diversion operation within 1 year of initial surgery. The authors compared failure rates of ETV and shunt, as well as patient demographics and clinical characteristics, using hierarchical regression according to treatment group. Results During the period examined, 872 infants (16.1%) initially underwent ETV and 4544 (83.9%) underwent ventricular shunt placement. The median infant age was 37 days (IQR 11–122 days) for both ETV and shunt placement. More infants who underwent ETV rather than shunt placement were born prematurely (41.6% vs 23.9%, respectively; p < 0.01) and had intraventricular hemorrhage (45.4% vs 17.5%, respectively; p < 0.01). Higher operative failure rates at 1 year were observed in infants who underwent ETV as opposed to shunt surgery (64.5% vs 39.6%, respectively; OR 2.9 [95% CI 2.3–3.5], p < 0.01). After controlling for prematurity, intraventricular hemorrhage, and spina bifida, ETV remained associated with a higher risk of failure (OR 2.6 [95% CI 2.1–3.2]). Conclusions In infants with hydrocephalus, a greater 1-year CSF diversion failure rate may occur after ETV compared with shunt placement. This risk is most significant for procedures performed within the first 90 days of life. Further investigation of the need for multiple reoperations, cost, and impact of surgeon and hospital experience is necessary to distinguish which treatment is more effective in the long term.

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