A Prospective Study of Endoscopic Third Ventriculostomy in Pediatric Andadult Hydrocephalus

OBJECTIVEHigh-quality data comparing endoscopic third ventriculostomy (ETV) with choroid plexus cauterization (CPC) to shunt and ETV alone in North America are greatly lacking. To address this, the Hydrocephalus Clinical Research Network (HCRN) conducted a prospective study of ETV+CPC in infants. Here, these prospective data are presented and compared to prospectively collected data from a historical cohort of infants treated with shunt or ETV alone.METHODSFrom June 2014 to September 2015, infants (corrected age ≤ 24 months) requiring treatment for hydrocephalus with anatomy suitable for ETV+CPC were entered into a prospective study at 9 HCRN centers. The rate of procedural failure (i.e., the need for repeat hydrocephalus surgery, hydrocephalus-related death, or major postoperative neurological deficit) was determined. These data were compared with a cohort of similar infants who were treated with either a shunt (n = 969) or ETV alone (n = 74) by creating matched pairs on the basis of age and etiology. These data were obtained from the existing prospective HCRN Core Data Project. All patients were observed for at least 6 months.RESULTSA total of 118 infants underwent ETV+CPC (median corrected age 1.3 months; common etiologies including myelomeningocele [30.5%], intraventricular hemorrhage of prematurity [22.9%], and aqueductal stenosis [21.2%]). The 6-month success rate was 36%. The most common complications included seizures (5.1%) and CSF leak (3.4%). Important predictors of treatment success in the survival regression model included older age (p = 0.002), smaller preoperative ventricle size (p = 0.009), and greater degree of CPC (p = 0.02). The matching algorithm resulted in 112 matched pairs for ETV+CPC versus shunt alone and 34 matched pairs for ETV+CPC versus ETV alone. ETV+CPC was found to have significantly higher failure rate than shunt placement (p < 0.001). Although ETV+CPC had a similar failure rate compared with ETV alone (p = 0.73), the matched pairs included mostly infants with aqueductal stenosis and miscellaneous other etiologies but very few patients with intraventricular hemorrhage of prematurity.CONCLUSIONSWithin a large and broad cohort of North American infants, our data show that overall ETV+CPC appears to have a higher failure rate than shunt alone. Although the ETV+CPC results were similar to ETV alone, this comparison was limited by the small sample size and skewed etiological distribution. Within the ETV+CPC group, greater extent of CPC was associated with treatment success, thereby suggesting that there are subgroups who might benefit from the addition of CPC. Further work will focus on identifying these subgroups.

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Effect of endoscopic third ventriculostomy on neuropsychological outcome in late onset idiopathic aqueduct stenosis: a prospective study

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp.74.2.222 ◽

2003 ◽

Vol 74 (2) ◽

pp. 222-225 ◽

Cited By ~ 24

Author(s):

J Burtscher ◽

L Bartha ◽

K Twerdy ◽

W Eisner ◽

T Benke

Keyword(s):

Prospective Study ◽

Endoscopic Third Ventriculostomy ◽

Late Onset ◽

Third Ventriculostomy ◽

Neuropsychological Outcome ◽

Aqueduct Stenosis ◽

A Prospective Study

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Comparison of endoscopic third ventriculostomy alone and combined with choroid plexus cauterization in infants younger than 1 year of age: a prospective study in 550 African children

Journal of Neurosurgery Pediatrics ◽

10.3171/ped.2005.103.6.0475 ◽

2005 ◽

Vol 103 (6) ◽

pp. 475-481 ◽

Cited By ~ 56

Author(s):

Benjamin C. Warf

Keyword(s):

Prospective Study ◽

Choroid Plexus ◽

Endoscopic Third Ventriculostomy ◽

Third Ventriculostomy ◽

African Children ◽

A Prospective Study ◽

Choroid Plexus Cauterization

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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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OBSTRUCTIVE HYDROCEPHALUS;

The Professional Medical Journal ◽

10.29309/tpmj/2019.26.02.3115 ◽

2019 ◽

Vol 26 (02) ◽

Author(s):

NAUMAN Shakeel ◽

Aaamir Aziz ◽

Muhammad Faaiq Farooq ◽

Faheem Usmani ◽

Tariq Salahuddin

Keyword(s):

Intracranial Hemorrhage ◽

Endoscopic Third Ventriculostomy ◽

Obstructive Hydrocephalus ◽

Third Ventricle ◽

Case Series ◽

Signs And Symptoms ◽

Third Ventriculostomy ◽

Traditional Treatment ◽

Operative Evaluation ◽

A Prospective Study

Introduction: Management of Hydrocephalus has always amazed and challenged clinicians throughout the history of medicine. The traditional treatment for all forms of hydrocephalus has been the implantation of Ventriculoperitoneal Shunt (VPS) system. Because of deployment of implant, this procedure inherently associated with certain common complications, infection approximately 24.6% of all shunt operations. Moreover, the risk of postoperative seizures is 25% and intracranial hemorrhage is 3.5%. Endoscopic Third Ventriculostomy (ETV) is a surgical procedure that allows the Cerebrospinal Fluid (CSF) to flow directly from the third ventricle to the basal cisterns and subarachnoid spaces, ETV has been established as a safe treatment for obstructive hydrocephalus because in this procedure there is no implant is deployed, that’s why rate of post operative complications is low as compare to VPS as intracranial infection found in 8% patient, intracranial hemorrhage in 5%and 1% patient developed seizure post ETV. Objectives: Objective of this study is to determine the frequency of short term complications of endoscopic third ventriculostomy in obstructive hydrocephalus. Study Design: Descriptive case series. Setting: Department of Neurosurgery, Lahore General Hospital, Lahore. Duration with Dates: Six months: from 01-07-2011 to 31-12-2011. Methods: This was a prospective study of in which 45 patients underwent Endoscopic third ventriculostomy for Obstructive hydrocephalus. The outcome of interest was to assess the frequency of complications like infection, hemorrhage and seizures following the ETV in patient with obstructive hydrocephalus. Data was collected on a specially designed Performa. Demographic details, signs and symptoms at presentation, details of post operative evaluation (mortality and neurological deficiency) were noted. Results: A total of 45 patients underwent in ETV for the treatment of obstructive hydrocephalus. Complications were observed in eight (17.8%) cases in which five patients had only one complication and three patients had multiple (two) complications. Regarding type of complication, Infection was observed in six (13.3%) cases, hemorrhage was observed in four (8.9%) cases and wound CSF leakages was seen in only one (2.2%) case. Conclusion: Endoscopic third ventriculostomy is recent advances in the management of obstructive hydrocephalus, it has lesser complications (Infection, Hemorrhage, seizures) and long term failure rate is low as compare to the traditional treatment of obstructive hydrocephalus.

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