scholarly journals Efficacy and Safety of Endoscopic Third Ventriculostomy in Obstructive Hydrocephalus

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

scholarly journals Endoscopic Third Ventriculostomy in Previously Shunted Children

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Eva Brichtova ◽  
Martin Chlachula ◽  
Tomas Hrbac ◽  
Radim Lipina
Keyword(s):  
Success Rate ◽  
Fourth Ventricle ◽  
Pediatric Patients ◽  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
Surgical Revision ◽  
Clinical State ◽  
Third Ventriculostomy ◽  
Safe Procedure ◽  
Shunt Implantation

Endoscopic third ventriculostomy (ETV) is a routine and safe procedure for therapy of obstructive hydrocephalus. The aim of our study is to evaluate ETV success rate in therapy of obstructive hydrocephalus in pediatric patients formerly treated by ventriculoperitoneal (V-P) shunt implantation. From 2001 till 2011, ETV was performed in 42 patients with former V-P drainage implantation. In all patients, the obstruction in aqueduct or outflow parts of the fourth ventricle was proved by MRI. During the surgery, V-P shunt was clipped and ETV was performed. In case of favourable clinical state and MRI functional stoma, the V-P shunt has been removed 3 months after ETV. These patients with V-P shunt possible removing were evaluated as successful. In our group of 42 patients we were successful in 29 patients (69%). There were two serious complications (4.7%)—one patient died 2.5 years and one patient died 1 year after surgery in consequence of delayed ETV failure. ETV is the method of choice in obstructive hydrocephalus even in patients with former V-P shunt implantation. In case of acute or scheduled V-P shunt surgical revision, MRI is feasible, and if ventricular system obstruction is diagnosed, the hydrocephalus may be solved endoscopically.

scholarly journals Endoscopic third ventriculostomy for obstructive hydrocephalus

2020 ◽  
pp. 269-274
Author(s):  
Hassan Z.A. Dixon ◽  
Yasir M. Hamandi ◽  
Ammar M.A. Mahmmoud ◽  
Samer S. Hoz ◽  
Zahraa F. Al-Sharshahi
Keyword(s):  
Success Rate ◽  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
Csf Leak ◽  
Third Ventriculostomy ◽  
Success Rates ◽  
Shunt Insertion ◽  
Female Ratio ◽  
Common Cause ◽  
Select Group

Introduction: Obstructive hydrocephalus has long been managed by valve-regulated shunts. These shunts are associated with a myriad of short and long-term complications. This has fueled interest in Endoscopic Third Ventriculostomy (ETV) which provides a more physiological pathway for cerebrospinal fluid (CSF) diversion while avoiding many shunt-related complications. Aim: The objective of this study is to analyze the outcomes of ETV at our institution, focusing on the indications, success rates, and short-term complications. Methods: Between July 2010 and September 2015, 47 patients with obstructive hydrocephalus underwent ETV at the Neurosurgery Teaching Hospital in Baghdad/ Iraq. We retrospectively analyzed the data of these patients using hospital health records. Simple statistics were performed using  SPSS Version 20. A standardized surgical technique was employed in all cases. Results: The mean age was 4.4 years (range 40 days - 38 years). The male: female ratio was 1.23:1 (55% males and 45% females). The most common cause of obstructive hydrocephalus in patients undergoing ETV was aqueductal stenosis (62%; N=29). The second most common cause was posterior fossa tumours (23%; N=11). The overall success rate for ETV was 68%. The net post-operative complication rate was 13% (N=6). CSF leak and seizures were the only two charted post-operative complications at the rates of 9%(N=4) and 4% (N=2), accordingly. No deaths were recorded. Conclusion: ETV is a viable alternative to shunt insertion in a select group of patients with obstructive hydrocephalus, with acceptable success rate and safety profile.

Use of the ETV Success Score to explain the variation in reported endoscopic third ventriculostomy success rates among published case series of childhood hydrocephalus

2011 ◽  
Vol 7 (2) ◽  
pp. 143-146 ◽  
Author(s):  
Abhaya V. Kulkarni ◽  
Jay Riva-Cambrin ◽  
Samuel R. Browd
Keyword(s):  
Success Rate ◽  
Correlation Coefficient ◽  
Intraclass Correlation Coefficient ◽  
Endoscopic Third Ventriculostomy ◽  
Intraclass Correlation ◽  
Case Series ◽  
Third Ventriculostomy ◽  
Success Rates ◽  
Significant Difference ◽  
Childhood Hydrocephalus

Object Published case series of endoscopic third ventriculostomy (ETV) for childhood hydrocephalus have reported widely varying success rates. The authors recently developed and internally validated the ETV Success Score (ETVSS); this is a simplified means of predicting the 6-month success rate of ETV for a child with hydrocephalus, based on age, etiology of hydrocephalus, and presence of a previous shunt. The authors hypothesized that the ETVSS would be able to predict with reasonable accuracy the actual ETV success rate reported among published case series. Methods A literature search was performed to identify published pediatric ETV papers that contained enough information with which to calculate an aggregate, mean predicted ETVSS for the cohort. This was then compared with the actual ETV success rate in the cohort. Data were extracted independently in triplicate, including by 2 individuals who were not involved with the development of the ETVSS. Results Fifteen papers reporting on 322 patients were included. Interrater reliability was very high in determining the predicted ETVSS (intraclass correlation coefficient 0.99). The predicted ETVSS for each paper agreed strongly with the actual ETV success rate reported in each paper (reliability intraclass correlation coefficient 0.81). There was no significant difference in the magnitude of the predicted ETVSS and the actual ETV success (p = 0.98, paired t-test). In a linear regression model, the predicted ETVSS explained 62% of the variation in actual ETV success. When the entire cohort was combined and analyzed together, the overall mean predicted ETVSS was 57.9%, which was nearly identical to the actual ETV success rate of 59.2%. Conclusions The ETVSS closely predicts the actual ETV success rate reported in selected papers published over the last 20 years and explains much of the variation.

scholarly journals ETV and choroid plexus coagulation: a critical analysis

2020 ◽  
Vol 3 (1(January-April)) ◽  
pp. e702020
Author(s):  
Marcelo Volpon Santos
Keyword(s):  
Success Rate ◽  
Choroid Plexus ◽  
Endoscopic Third Ventriculostomy ◽  
Scientific Evidence ◽  
Case Series ◽  
Historical Background ◽  
Third Ventriculostomy ◽  
Communicating Hydrocephalus ◽  
Success Rates ◽  
Mesh Terms

Objective: To analyze the current medical literature regarding the addition of choroid plexus coagulation (CPC) to an endoscopic third ventriculostomy (ETV), with the aim of improving its efficacy. The historical background and rationale for these procedures are also presented. Methods: A Pubmed search using MeSH terms “choroid plexus coagulation” and “endoscopic third ventriculostomy” was performed in October 2020, retrieving 107 papers. A summary of the findings of these articles is provided, with a particular emphasis on the ones with higher scientific evidence levels (two systematic reviews with meta-analyses and three prospective studies with large case series). The following questions should be answered: “Does CPC add to the success rate of ETV, and in comparison, with shunts?” “Which clinical and surgical factors contribute to positive results of CPC / ETV?” And “Does CPC add morbidity / mortality to endoscopic surgery?” Results/Discussion: There is significant evidence to support that CPC adds up to the success rates of ETV; this is particularly true in the context of the so-called “communicating hydrocephalus”, especially for patients with post-infectious and post-hemorrhagic hydrocephalus. Nevertheless, patients with “obstructive” etiologies also benefit from CPC + ETV. Pooled success was estimated at around 63%, and successful results as measured by shunt-free rates ranged from 49% to 75%. The highest benefit was observed in patients above 6 months of age. Other factors that might have an influence in success rates include extent of cauterization and, understandably, the use of flexible endoscopes, that allow for coagulating greater amounts of choroid plexus. Morbidity rates were not affected and remained similar to ETV and other neuroendoscopic procedures alone (around 1% overall). Conclusion: The addition of CPC to an ETV can be quite beneficial and improve its success rate; this combination is certainly useful to avoid shunts. Nevertheless, patient selection and a thorough knowledge of the surgical indications and techniques is still required to achieve satisfactory results.

Endoscopic third ventriculostomy for tumor-related hydrocephalus in a pediatric population

2005 ◽  
Vol 19 (6) ◽  
pp. 1-4 ◽  
Author(s):  
Pulak Ray ◽  
George I. Jallo ◽  
R. Y. H. Kim ◽  
Bong-Soo Kim ◽  
Sean Wilson ◽  
...  
Keyword(s):  
Success Rate ◽  
Patency Rate ◽  
Endoscopic Third Ventriculostomy ◽  
Pediatric Population ◽  
Obstructive Hydrocephalus ◽  
Management Tool ◽  
Third Ventriculostomy ◽  
Pineal Tumor ◽  
Success Rates ◽  
Primary Procedure

Object Endoscopic third ventriculostomy (ETV) has become a common alternative for managing hydrocephalus in select patients. Nevertheless, there is still controversy regarding the indications for ETV as the primary procedure, given its variable success rates. The purpose of this study is to review the authors' experience with ETV for a variety of patients. Methods A total of 43 children underwent ETV between July 1992 and June 2003. Their medical records, operative reports, and imaging studies, when available, were retrospectively reviewed with regard to outcome, complications, and patency rate. Treatment failure was defined as the need to place a shunt within 4 weeks of performing ETV in the patient. There were 20 male and 23 female patients with a mean age of 9.6 years (range 8 weeks–21 years). The overall success rate was 69.8%, and the mean follow-up duration was 24.6 months. Six patients underwent eight repeated ETVs at a mean interval of 25 months, with a patency rate of 62.5% after the second procedure. Only two surgeries were aborted for anatomical reasons. The highest success rates (100% in each instance) were achieved for obstructive hydrocephalus resulting from midbrain/tectal tumor (four patients) and pineal tumor (three patients). Conclusions The ETV procedure is an effective management tool for obstructive hydrocephalus in children. It should be considered the primary procedure, rather than ventriculoperitoneal shunts, in carefully selected children. The success rate is dependent on the origin of the hydrocephalus.

scholarly journals Effectiveness and success rates of endoscopic third ventriculostomy in patients under 2 years old

2021 ◽  
Vol 7 (2) ◽  
pp. 67-71
Author(s):  
Murat Ertaş ◽  
Derya Karaoğlu Gündoğdu ◽  
Mert Şahinoğlu ◽  
Ender Köktekir ◽  
Hakan Karabağlı
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
Treatment Method ◽  
Physiological Solution ◽  
Third Ventriculostomy ◽  
Success Rates ◽  
Repeat Surgery ◽  
Technical Developments ◽  
Shunt Dysfunction ◽  
Time Of Operation

Objective: Endoscopic third ventriculostomy (ETV) stands out as an important option in the treatment of hydrocephalus without shunts. Endoscopic third ventriculostomy (ETV) has become more popular due to recent technical developments in endoscopic systems. But the urge of the physician, to provide a shuntfree survival for his patients, leads to performing the procedure in a unsuitable group of patients. Compared with shunt surgery, ETV presents a more physiological solution for the treatment of hydrocephalus. ETV is accepted as the first-line treatment method in many centers in appropriate cases in the treatment of obstructive hydrocephalus. The aim of this study is to examine the results of patients under the age of two underwent endoscopic third ventriculostomy. Methods: 79 patients who underwent ETV between 2011 and 2020 in our clinic and who were under 2 years of age at the time of operation were retrospectively analyzed. Results: 45 of 79 patients were male babies and 34 were female babies. The average age of the patients is 7 months (1 day - 22 months). In 39 (49.3%) patients, there was no need for repeat surgery in their follow-up after ETV. ETV procedure was repeated in 5 (6.3%) patients, and ventriluloperitoneal shunt (VPS) surgery was performed in 2 (2.5%) patients. In 13 patients, ventriculoperitoneal shunt was applied from the anterior and presented with shunt dysfunction. VPS surgery was not performed again after ETV in 3 (23%) of 13 patients after ETV. Conclusions: ETV can also be applied to patients younger than two years of age, and this treatment can give patients the chance to live a life independent of shunt.

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.

Fatal subarachnoid hemorrhage after endoscopic third ventriculostomy

1999 ◽  
Vol 90 (1) ◽  
pp. 153-155 ◽  
Author(s):  
Henry W. S. Schroeder ◽  
Rolf W. Warzok ◽  
Jamal A. Assaf ◽  
Michael R. Gaab
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Computerized Tomography ◽  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
Balloon Catheter ◽  
Third Ventriculostomy ◽  
Safe Procedure ◽  
Content Type ◽  
Tomography Scanning ◽  
Fine Print

✓ In recent years, endoscopic third ventriculostomy has become a well-established procedure for the treatment of various forms of noncommunicating hydrocephalus. Endoscopic third ventriculostomy is considered to be an easy and safe procedure. Complications have rarely been reported in the literature. The authors present a case in which the patient suffered a fatal subarachnoid hemorrhage (SAH) after endoscopic third ventriculostomy.This 63-year-old man presented with confusion and drowsiness and was admitted in to the hospital in poor general condition. Computerized tomography scanning revealed an obstructive hydrocephalus caused by a tumor located in the cerebellopontine angle. An endoscopic third ventriculostomy was performed with the aid of a Fogarty balloon catheter. Some hours postoperatively, the patient became comatose. Computerized tomography scanning revealed a severe perimesencephalic—peripontine SAH and progressive hydrocephalus. Despite emergency external ventricular drainage, the patient died a few hours later.Although endoscopic third ventriculostomy is considered to be a simple and safe procedure, one should be aware that severe and sometimes fatal complications may occur. To avoid vascular injury, perforation of the floor of the third ventricle should be performed in the midline, halfway between the infundibular recess and the mammillary bodies, just behind the dorsum sellae.

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.

scholarly journals Upward transtentorial herniation: A new role for endoscopic third ventriculostomy

2021 ◽  
Vol 12 ◽  
pp. 334
Author(s):  
Júlia Moscardini-Martelli ◽  
Juan Antonio Ponce-Gomez ◽  
Victor Alcocer-Barradas ◽  
Samuel Romano-Feinholz ◽  
Pilar Padilla-Quiroz ◽  
...  
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
External Ventricular Drainage ◽  
Hemorrhagic Transformation ◽  
Third Ventriculostomy ◽  
Safe Procedure ◽  
Cerebellar Stroke ◽  
Transtentorial Herniation ◽  
Suboccipital Craniectomy ◽  
Upward Herniation

Background: The placement of external ventricular drainage (EVD) to treat hydrocephalus secondary to a cerebellar stroke is controversial because it has been associated to upward transtentorial herniation (UTH). This case illustrates the effectiveness of endoscopic third ventriculostomy (ETV) after the ascending herniation has occurred. Case Description: A 50-year-old man had a cerebellar stroke with hemorrhagic transformation, tonsillar herniation, and non-communicating obstructive hydrocephalus. Considering that the patient was anticoagulated and thrombocytopenic, an EVD was placed initially, followed by clinical deterioration and UTH. We performed a suboccipital craniectomy immediately after clinical worsening, but the patient did not show clinical or radiological improvement. On the 5th day, we did an ETV, which reverses the upward herniation and hydrocephalus. The patient improved progressively with good neurological recovery. Conclusion: ETV is an effective and safe procedure for obstructive hydrocephalus. The successful resolution of the patient’s upward herniation after the ETV offers a potential option to treat UTH and advocates further research in this area.

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