scholarly journals Intratumoral Hemorrhage After Endoscopic Third Ventriculostomy for Obstructive Hydrocephalus Caused by Brain Tumors

2021 ◽  
Author(s):  
Akira Taguchi ◽  
Yasuyuki Kinoshita ◽  
Vishwa Jeet Amatya ◽  
Takeshi Takayasu ◽  
Motoki Takano ◽  
...  
Keyword(s):  
Obstructive Hydrocephalus ◽  
Patient Characteristics ◽  
Aqueductal Stenosis ◽  
Endoscopic Biopsy ◽  
Third Ventriculostomy ◽  
Histopathological Diagnosis ◽  
Intratumoral Hemorrhage ◽  
Minimal Invasiveness ◽  
Hemorrhagic Risk ◽  
Atypical Teratoid

Abstract IntroductionEndoscopic third ventriculostomy (ETV) for obstructive hydrocephalus and endoscopic biopsy (EB) for intra- and paraventricular tumors are recognized as standard therapies because of their minimal invasiveness. Although EB-associated hemorrhagic risk has been well documented, reports on the ETV-associated hemorrhagic risk are only few. Therefore, we conducted this retrospective study to review the incidence of hemorrhage due to EB and/or ETV in a single institution.Material and MethodsWe retrospectively reviewed data, including patient characteristics, procedure, pathological findings, and complications, including hemorrhage, of 100 patients with intra- and paraventricular tumors who underwent EB and/or ETV at our institution from 2000 to 2020.ResultsEB and ETV combined surgery (combined group), EB-alone surgery (EB-alone group), and ETV-alone surgery (ETV-alone group) were performed in 44 (44%), 24 (24%), and 32 (32%) patients, respectively, and all procedures were successful. The rates of definitive and suggestive diagnoses in EB were 76.5% and 23.5%, respectively. Adverse events were observed in six patients. An acute obstruction of the ETV stoma and a transient double vision were observed in the combined group. Two transient aqueductal stenosis/obstructions were recognized in the EB-alone group. Hemorrhage was observed in two patients in the ETV-alone group; these patients developed intratumoral hemorrhage despite ETV-alone surgery. Subsequently, these two patients underwent tumor removal, and the histopathological diagnosis was atypical teratoid/rhabdoid tumor (AT/RT) in both.ConclusionsFor obstructive hydrocephalus with AT/RTs, physicians must be aware of the risk of postoperative intratumoral hemorrhage after performing ETV.Trial registration numberE-2385 (2021/3/11)

Endoscopic Third Ventriculostomy in Infants Less than One Year of Age: A Short Series of 14 Cases

2021 ◽  
Vol 56 (2) ◽  
pp. 105-109
Author(s):  
Sarita Chowdhary ◽  
Shyamendra Pratap Sharma ◽  
Pranaya Panigrahi ◽  
Manoj Kumar Yadav ◽  
Shiv Prasad Sharma
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
Aqueductal Stenosis ◽  
Csf Shunt ◽  
Third Ventriculostomy ◽  
Occipital Encephalocele ◽  
Shunt Implantation ◽  
Permanent Morbidity ◽  
One Year

<b><i>Background:</i></b> Endoscopic third ventriculostomy (ETV) is currently considered as an alternative to cerebrospinal fluid (CSF) shunt systems in the treatment of obstructive hydrocephalus. This procedure allows the CSF to drain in the basal cisterns and reabsorbed by arachnoid granulations, and avoiding implantation of exogenous material. <b><i>Aims and Objectives:</i></b> The purpose of this study was to assess the success rate of ETV in infants less than 1 year of age with congenital noncommunicating hydrocephalus. <b><i>Material and Methods:</i></b> This study was a 2-year prospective study from August 2017 to July 2019. ETVs were performed in 14 patients younger than 1 year with diagnosis of noncommunicating hydrocephalous. A failure was defined as the need for shunt implantation after ETV. Phase-contrast MRI of the brain was done after 6 months to see patency of ETV fenestration and CSF flow through ventriculostomy. <b><i>Results:</i></b> ETV was tried in 18 patients and successfully performed in 14 patients. Out of the 14 patients, shunt implantation after ETV was performed in 3 patients (failed ETV). In the successful cases, etiology was idiopathic aqueductal stenosis in 8, shunt complications in 2, and 1 case was a follow-up case of occipital encephalocele; the mean age was 7.7 months (range 3–12). In the 3 failed cases, etiology was aqueductal stenosis, mean age was 7.6 months (range 3–11). In all ETVs, failed patients MPVP shunting was done. Follow-up of nonshunted patients was done from 6 to 24 months (mean 15 months). There was no mortality or permanent morbidity noted following ETV. <b><i>Conclusion:</i></b> ETV is a good surgical procedure for less than 1-year-old children.

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.

Stereotactic third ventriculostomy in patients with nontumoral adolescent/adult onset aqueductal stenosis and symptomatic hydrocephalus

1991 ◽  
Vol 75 (6) ◽  
pp. 865-873 ◽  
Author(s):  
Patrick J. Kelly
Keyword(s):  
Obstructive Hydrocephalus ◽  
Aqueductal Stenosis ◽  
Primary Treatment ◽  
Target Point ◽  
Third Ventriculostomy ◽  
Computer Assisted ◽  
Adult Onset ◽  
Absorption Mechanism ◽  
Content Type ◽  
Cerebrospinal Fluid Absorption

✓ Sixteen consecutive patients with obstructive hydrocephalus due to nontumoral aqueductal stenosis of adolescent or adult onset underwent computerized tomography-guided stereotactic third ventriculostomy. Computer-assisted angiographic target-point cross-registration was used in surgical planning to reduce morbidity. The procedure was used as primary treatment in five previously unshunted patients and in 11 patients who had previously received shunts and who presented when their shunts became obstructed (five patients), became infected (five patients), or required multiple revisions (one patient). At the time of third ventriculostomy, shunt hardware was removed in patients with infected shunts and the distal element of the shunt was ligated in all patients with obstructed shunts except one, who later required repeat third ventriculostomy; the distal shunt was ligated at that time. Follow-up data (range 1 to 5 years, mean 3½ years, after surgery) showed that only one of the 16 patients had undergone a shunting procedure after the third ventriculostomy. The other 15 patients are asymptomatic and shunt-independent. In previously shunt-dependent patients, the peripheral subarachnoid space and cerebrospinal fluid absorption mechanism remained patent in spite of shunts placed earlier. Therefore, in patients with obstructive hydrocephalus due to aqueductal stenosis of adolescent or adult onset, stereotactic third ventriculostomy should be seriously considered as primary surgical management in previously unshunted patients and in shunt-dependent patients with obstructed or infected shunts.

Efficacy and Safety of Endoscopic Transventricular Lamina Terminalis Fenestration for Hydrocephalus

Neurosurgery ◽  
2012 ◽  
Vol 71 (2) ◽  
pp. 464-473 ◽  
Author(s):  
Leonardo Rangel-Castilla ◽  
Steven W. Hwang ◽  
Andrew Jea ◽  
Jaime Torres-Corzo
Keyword(s):  
Ventriculoperitoneal Shunt ◽  
Perioperative Complications ◽  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Significant Risk ◽  
Good Alternative ◽  
Aqueductal Stenosis ◽  
Third Ventriculostomy ◽  
Lamina Terminalis ◽  
Transforaminal Approach

Abstract BACKGROUND: Endoscopic third ventriculostomy (ETV) has become the procedure of choice in the treatment of obstructive hydrocephalus. In certain cases, standard ETV might not be technically possible or may engender significant risk. OBJECTIVE: To present an alternative through the lamina terminalis (LT) by a transventricular, transforaminal approach with flexible neuroendoscopy and to discuss the indications, technique, neuroendoscopic findings, and outcomes. METHODS: Between 1994 and 2010, all patients who underwent endoscopic LT fenestration as an alternative to ETV were analyzed and prospectively followed up. The decision to perform an LT fenestration was made intraoperatively. RESULTS: Twenty-five patients, ranging in age from 7 months to 76 years (mean, 28.1 years), underwent endoscopic LT fenestration. Patients had obstructive hydrocephalus secondary to neurocysticercosis (11 patients), neoplasms (6 patients), congenital aqueductal stenosis (3 patients), and other (5 patients). Thirteen patients (52%) had had at least 1 ventriculoperitoneal shunt that malfunctioned; 6 patients (24%) had undergone a previous endoscopic procedure. Intraoperative findings that led to an LT fenestration were the following: ETV not feasible to perform, basal subarachnoid space not sufficient, or adhesions in the third ventricle. No perioperative complications occurred. The mean follow-up period was 63.76 months. Overall, 19 patients (76%) had resolutions of symptoms, had no evidence of ventriculomegaly, and did not require another procedure. Six (24%) required a ventriculoperitoneal shunt. CONCLUSION: Endoscopic transventricular transforaminal LT fenestration with flexible neuroendoscopy is feasible with a low incidence of complications. It is a good alternative to standard ETV. Adequate intraoperative assessment of ETV success is necessary to identify patients who will benefit.

scholarly journals Endoscopic third ventriculostomy in the treatment of hydrocephalus: A 20-year retrospective analysis of 209 consecutive cases

2021 ◽  
Vol 12 ◽  
pp. 383
Author(s):  
Igor Vilela Faquini ◽  
Ricardo Brandão Fonseca ◽  
Alyne Oliveira Correia ◽  
Auricelio Batista Cezar Junior ◽  
Eduardo Vieira De Carvalho Junior ◽  
...  
Keyword(s):  
Success Rate ◽  
Endoscopic Third Ventriculostomy ◽  
Clinical Success ◽  
Obstructive Hydrocephalus ◽  
Aqueductal Stenosis ◽  
Third Ventriculostomy ◽  
Csf Fistula ◽  
Group A ◽  
Independent Risk Factors ◽  
Group B

Background: Endoscopic third ventriculostomy (ETV) has been shown to be a sufficient alternative to shunts in surgical treatment of obstructive hydrocephalus. Long-term failure, age limitations, and outcome by cause are some of the issues debated in literature. The objective of this article is to analyze the clinical success and failure of ETV and its main complications. Methods: A total of 209 patients with hydrocephalus were submitted to ETV, including a mixed population of children and adults (from 0 to 59 years). Patients were divided into five groups: A – tumors, B – aqueductal stenosis, C – myelomeningocele, D – infection and hemorrhage, and E – arachnoid cyst. Variables were analyzed: age, ETV success rate, cerebrospinal fluid (CSF) fistula, mortality, and complications. Results: The two main causes of hydrocephalus were tumors (44.9%) and aqueductal stenosis (25.3%). The overall success rate was of 82.8%, and patients in Group E had the highest rate 90.9%. Group A had a success rate of 89.3%, and Group B had a rate of 88.6%. The ETV success rate was significantly higher in patients older than 1 year (P < 0.001); the former also had a lower risk of CSF fistula (P < 0.0001). The overall mortality rate was 2.8%. Conclusion: Better results were observed in the groups of patients with tumors, aqueductal stenosis, and arachnoid cysts, while those whose primary causes of hydrocephalus were myelomeningocele, infections, or bleeding had higher rates of failure after the procedure. This study demonstrated that age under 1 year and hydrocephalus caused by myelomeningocele, bleeding, and infection were considered independent risk factors of poor prognosis in ETV.

Lower rates of symptom recurrence and surgical revision after primary compared with secondary endoscopic third ventriculostomy for obstructive hydrocephalus secondary to aqueductal stenosis in adults

2016 ◽  
Vol 124 (5) ◽  
pp. 1413-1420 ◽  
Author(s):  
Eric W. Sankey ◽  
C. Rory Goodwin ◽  
Ignacio Jusué-Torres ◽  
Benjamin D. Elder ◽  
Jamie Hoffberger ◽  
...  
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
Aqueductal Stenosis ◽  
Symptomatic Improvement ◽  
Surgical Revision ◽  
Third Ventriculostomy ◽  
Timed Up And Go ◽  
Shunt Placement ◽  
Increased Risk ◽  
Symptom Recurrence

OBJECT Endoscopic third ventriculostomy (ETV) is the treatment of choice for obstructive hydrocephalus; however, the success of ETV in patients who have previously undergone shunt placement remains unclear. The present study analyzed 103 adult patients with aqueductal stenosis who underwent ETV for obstructive hydrocephalus and evaluated the effect of previous shunt placement on post-ETV outcomes. METHODS This study was a retrospective review of 151 consecutive patients who were treated between 2007 and 2013 with ETV for hydrocephalus. One hundred three (68.2%) patients with aqueductal stenosis causing obstructive hydrocephalus were included in the analysis. Postoperative ETV patency and aqueductal and cisternal flow were assessed by high-resolution, gradient-echo MRI. Post-ETV Mini-Mental State Examination, Timed Up and Go, and Tinetti scores were compared with preoperative values. Univariate and multivariate analyses were performed comparing the post-ETV outcomes in patients who underwent a primary (no previous shunt) ETV (n = 64) versus secondary (previous shunt) ETV (n = 39). RESULTS The majority of patients showed significant improvement in symptoms after ETV; however, no significant differences were seen in any of the quantitative tests performed during follow-up. Symptom recurrence occurred in 29 (28.2%) patients after ETV, after a median of 3.0 (interquartile range 0.8–8.0) months post-ETV failure. Twenty-seven (26.2%) patients required surgical revision after their initial ETV. Patients who received a secondary ETV had higher rates of symptom recurrence (p = 0.003) and surgical revision (p = 0.003), particularly in regard to additional shunt placement/revision post-ETV (p = 0.005). These differences remained significant after multivariate analysis for both symptom recurrence (p = 0.030) and surgical revision (p = 0.043). CONCLUSIONS Patients with obstructive hydrocephalus due to aqueductal stenosis exhibit symptomatic improvement after ETV, with a relatively low failure rate. Patients with a primary history of shunt placement who undergo ETV as a secondary intervention are at increased risk of symptom recurrence and need for surgical revision post-ETV.

scholarly journals Combined rigid and flexible endoscopy for tumors in the posterior third ventricle

2015 ◽  
Vol 122 (6) ◽  
pp. 1341-1346 ◽  
Author(s):  
Jonathan Roth ◽  
Shlomi Constantini
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Choroid Plexus Papilloma ◽  
Flexible Endoscopy ◽  
Endoscopic Biopsy ◽  
Third Ventriculostomy ◽  
Low Grade ◽  
Rigid Endoscope ◽  
Ventricular Tumors

OBJECT Tumors leading to occlusion of the sylvian aqueduct include those of pineal, thalamic, and tectal origins. These tumors cause obstructive hydrocephalus and thus necessitate a CSF diversion procedure such as an endoscopic third ventriculostomy (ETV), often coupled with an endoscopic biopsy (EBX). Lesions located posterior to the massa intermedia pose a technical challenge, as the use of a rigid endoscope for performing both an ETV and EBX is limited. The authors describe their experience using a combined rigid and flexible endoscopic procedure through a single bur hole for both procedures in patients with posterior third ventricular tumors. METHODS Since January 2012, patients with posterior third ventricular tumors causing hydrocephalus underwent dual ETV and EBX procedures using the combined rigid-flexible endoscopic technique. Following institutional review board approval, data from clinical, radiological, surgical, and pathological records were retrospectively collected. RESULTS Six patients 3.5–53 years of age were included. Lesion locations included pineal (n = 3), fourth ventricle (n = 1), aqueduct (n = 1), and tectum (n = 1). The ETV and EBX were successful in all cases. Pathologies included pilocytic astrocytoma, pineoblastoma, ependymoma Grade II, germinoma, low-grade glioneural tumor, and atypical choroid plexus papilloma. One patient experienced an immediate postoperative intraventricular hemorrhage necessitating evacuation of the clots and resection of the tumor, eventually leading to the patient's death. CONCLUSIONS The authors recommend using a combined rigid-flexible endoscope for endoscopic third ventriculostomy and biopsy to approach posterior third ventricular tumors (behind the massa intermedia). This technique overcomes the limitations of using a rigid endoscope by reaching 2 distant regions.

Spontaneous third ventriculostomy: definition by endoscopy and cerebrospinal fluid dynamics

2009 ◽  
Vol 111 (3) ◽  
pp. 628-631 ◽  
Author(s):  
Amit Parmar ◽  
Kristian Aquilina ◽  
Michael R. Carter
Keyword(s):  
Fluid Dynamics ◽  
Cerebrospinal Fluid ◽  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Aqueductal Stenosis ◽  
Third Ventriculostomy ◽  
Chronic Obstructive ◽  
Cerebrospinal Fluid Dynamics ◽  
The Third ◽  
And Function

Chronic obstructive hydrocephalus is known to cause ventricular diverticula and, rarely, spontaneous ventriculostomy. The authors present the case of a patient in whom a spontaneous third ventriculostomy was identified with long-standing hydrocephalus secondary to aqueductal stenosis. To their knowledge, this is the first report in which a spontaneous stoma in the floor of the third ventricle was evaluated using endoscopy and cerebrospinal fluid dynamics studies. Both studies confirmed that the spontaneous stoma is similar in structure and function to surgical third ventriculostomy.

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