The role of endoscopic third ventriculostomy in the treatment of hydrocephalus

2013 ◽  
Vol 12 (1) ◽  
pp. 54-61 ◽  
Author(s):  
Timothy W. Vogel ◽  
Biji Bahuleyan ◽  
Shenandoah Robinson ◽  
Alan R. Cohen
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Third Ventricle ◽  
Public Health Problem ◽  
High Rate ◽  
Third Ventriculostomy ◽  
Major Public Health Problem ◽  
Shunt System

Object Hydrocephalus remains a major public health problem. Conventional treatment has relied on extracranial shunting of CSF to another systemic site, but this approach is associated with a high rate of complications. Endoscopic third ventriculostomy (ETV) is a novel treatment for select forms of hydrocephalus that can eliminate the need for implantation of a lifelong ventricular shunt system. However, the indications for ETV are contested and its long-term effectiveness is not well established. Methods The authors selected 100 consecutive patients who underwent ETV for hydrocephalus beginning in 1994. Patients were enrolled and treated at a single institution by a single surgeon. The primary outcome was success of ETV, with success defined as no need for subsequent surgery for hydrocephalus. Results Ninety-five patients satisfied the inclusion criteria. The mean follow-up period was 5.1 years (median 4.7 years) with follow-up data available for as long as 17 years. Patients commonly presented with headache (85%), ataxia (34%), emesis (29%), and changes in vision (27%). The success rate for ETV was 75%. Twenty-one patients (22%) in the series had malfunctioning shunts preoperatively and 13 (62%) were successfully treated with ETV. Preoperative inferior bowing of the third ventricle floor on MRI was significantly associated with ETV success (p < 0.05). Conclusions Endoscopic third ventriculostomy is an effective and durable treatment for select patients with hydrocephalus. When successful, the procedure eliminates the lifelong complications associated with implanted ventricular shunts.

Crucial role of physiotherapy in treating COVID-19 patients

2020 ◽  
Vol 11 (SPL1) ◽  
pp. 967-971
Author(s):  
Poonam Thakre ◽  
Waqar M. Naqvi ◽  
Trupti Deshmukh ◽  
Nikhil Ingole ◽  
Sourabh Deshmukh
Keyword(s):  
Public Health ◽  
Distress Syndrome ◽  
Public Health Problem ◽  
Public Health Emergency ◽  
High Rate ◽  
Major Public Health Problem ◽  
Front Line ◽  
The Many ◽  
Sixth International

The emergence in China of 2019 of severe acute respiratory syndrome coronavirus2 (SARS-CoV-2) previously provisionally names 2019-nCoV disease (COVID19) caused major global outbreak and is a major public health problem. On 30 January 2020, the WHO declared COVID19 to be the sixth international public health emergency. This present pandemic has engrossed the globe with a high rate of mortality. As a front line practitioner, physiotherapists are expected to be getting in direct contact with patients infected with the virus. That’s why it is necessary for understanding the many aspects of their role in the identification, contains, reduces and treats the symptoms of this disease. The main presentation is the involvement of respiratory system with symptoms like fever, cough, sore throat, sneezing and characteristics of pneumonia leads to ARDS(Acute respiratory distress syndrome) also land up in multiorgan dysfunction syndrome. This text describes and suggests physiotherapy management of acute COVID-19 patients. It also includes recommendations and guidelines for physiotherapy planning and management. It also covers the guidelines regarding personal care and equipment used for treatment which can be used in the treatment of acute adult patients with suspected or confirmed COVID-19.

Purely Endoscopic Resection of Colloid Cysts

2008 ◽  
Vol 62 (suppl_1) ◽  
pp. ONS51-ONS56 ◽  
Author(s):  
Jeremy D.W. Greenlee ◽  
Charles Teo ◽  
Ali Ghahreman ◽  
Bernard Kwok
Keyword(s):  
Endoscopic Resection ◽  
Third Ventricle ◽  
Colloid Cyst ◽  
Foramen Of Monro ◽  
The Third ◽  
Colloid Cysts ◽  
Study Support

Abstract Objective: To further assess the safety and long-term efficacy of endoscopic resection of colloid cysts of the third ventricle. Methods: A retrospective review of a series of 35 consecutive patients (18 male, 17 female) with colloid cysts treated by endoscopic surgery was undertaken. Results: The mean patient age was 32.4 years (range, 11–54 yr). Headache was the most common presenting symptom (22 patients). The average tumor size was 18 mm (range, 3–50 mm). The endoscopic technique could not be completed in six patients, necessitating conversion to an open craniotomy and a transcortical approach to the colloid cyst. All patients had histologically confirmed colloid cysts of the third ventricle, and complete resection of the lesion was confirmed macroscopically and radiologically in all patients. There were no deaths. Two patients developed aseptic meningitis without any permanent sequelae. One patient developed unilateral hydrocephalus attributable to obstruction of the foramen of Monro, which was treated with endoscopic septum pellucidotomy. The median follow-up period was 88 months (range, 10–132 mo). There was one asymptomatic radiological recurrence. No seizures occurred after surgery. Conclusion: The results of this study support the role of endoscopic resection in the treatment of patients with colloid cysts as a safe and effective modality. In some cases, conversion to an open procedure may be required. Additional follow-up will be required to continue to address the duration of lesion-free survival.

Endoscopic Transventricular Transaqueductal Magendie and Luschka Foraminoplasty for Hydrocephalus

Neurosurgery ◽  
2013 ◽  
Vol 74 (4) ◽  
pp. 426-436 ◽  
Author(s):  
Jaime Torres-Corzo ◽  
Juan Sánchez-Rodríguez ◽  
Dominic Cervantes ◽  
Roberto Rodríguez-Della Vecchia ◽  
Fernando Muruato-Araiza ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Endoscopic Third Ventriculostomy ◽  
Outlet Obstruction ◽  
Third Ventriculostomy ◽  
Alternative Technique ◽  
Vp Shunt ◽  
Long Term Follow Up ◽  
Secondary Causes

ABSTRACT BACKGROUND: Routinely, hydrocephalus related to fourth ventricular outlet obstruction (FVOO) has been managed with ventriculoperitoneal (VP) shunting or endoscopic third ventriculostomy (ETV). Few reports on Magendie foraminoplasty exist, and Luschka foraminoplasty has not been described. OBJECTIVE: To present an alternative technique in the management of FVOO via an endoscopic transventricular transaqueductal Magendie and Luschka foraminoplasty and to discuss the indications, technique, findings, and outcomes. METHODS: Between 1994 and 2011, all patients who underwent endoscopic Magendie and Luschka foraminoplasty were analyzed. RESULTS: A total of 33 Magendie (28) and/or Luschka (5) foraminoplasties were performed in 30 patients. Twenty-three were adult and 7 were pediatric patients. The etiology of the FVOO was divided into primary etiologies (congenital membrane in 5 and atresia in 2) and secondary causes (neurocysticercosis in 14 patients, bacterial meningitis in 9). Fifteen (50%) had previously failed procedures. Intraoperative findings that led to Magendie/Luschka foraminoplasty were ETV not feasible to perform, nonpatent basal subarachnoid space, or primary FVOO. Minor postoperative complications were seen in 3 patients. Only 26 patients had long-term follow-up; 17 (65.3%) of these had clinical improvement and did not require further procedures. Nine (34.7%) did not improve. Eight required another procedure (7 shunts, and 1 endoscopic procedure). One patient died. CONCLUSION: Flexible neuroendoscopic transventricular transforaminal Magendie and Luschka foraminoplasty is feasible and safe. These procedures may prove to be viable alternatives to standard ETV and VP shunt in appropriate patients. Adequate intraoperative assessment of ETV success is necessary to identify patients who will benefit.

scholarly journals Role of Vitamin D Status in Diabetic Patients with Renal Disease

Medicina ◽  
2019 ◽  
Vol 55 (6) ◽  
pp. 273 ◽  
Author(s):  
Guido Gembillo ◽  
Valeria Cernaro ◽  
Antonino Salvo ◽  
Rossella Siligato ◽  
Alfredo Laudani ◽  
...  
Keyword(s):  
Vitamin D ◽  
Public Health Problem ◽  
The United States ◽  
Vitamin D Supplementation ◽  
Western World ◽  
Diabetic Patients ◽  
Major Public Health Problem

Diabetes mellitus (DM) poses a major public health problem worldwide, with ever-increasing incidence and prevalence in recent years. The Institute for Alternative Futures (IAF) expects that the total number of people with type 1 and type 2 DM in the United States will increase by 54%, from 19,629,000 to 54,913,000 people, between 2015 and 2030. Diabetic Nephropathy (DN) affects about one-third of patients with DM and currently ranks as the first cause of end-stage kidney disease in the Western world. The complexity of interactions of Vitamin D is directly related with progressive long-term changes implicated in the worsening of renal function. These changes result in a dysregulation of the vitamin D-dependent pathways. Various studies demonstrated a pivotal role of Vitamin D supplementation in regression of albuminuria and glomerulosclerosis, contrasting the increase of glomerular basement membrane thickening and podocyte effacement, with better renal and cardiovascular outcomes. The homeostasis and regulation of the nephron’s function are absolutely dependent from the cross-talk between endothelium and podocytes. Even if growing evidence proves that vitamin D may have antiproteinuric, anti-inflammatory and renoprotective effects in patients with DN, it is still worth investigating these aspects with both more in vitro studies and randomized controlled trials in larger patient series and with adequate follow-up to confirm the effects of long-term vitamin D analogue supplementation in DN and to evaluate the effectiveness of this therapy and the appropriate dosage.

The role of third ventricle bowing in the success of endoscopic third ventriculostomy in pediatric and adult patients

2019 ◽  
Vol 187 ◽  
pp. 105554 ◽  
Author(s):  
Tomáš Krejčí ◽  
Ondřej Krejčí ◽  
Zdeněk Večeřa ◽  
Martin Chlachula ◽  
Dana Šalounová ◽  
...  
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Third Ventricle ◽  
Adult Patients ◽  
Third Ventriculostomy

Third ventricular shape: a predictor of endoscopic third ventriculostomy success in pediatric patients

2011 ◽  
Vol 7 (4) ◽  
pp. 389-396 ◽  
Author(s):  
Mansoor Foroughi ◽  
Andrew Wong ◽  
Paul Steinbok ◽  
Ash Singhal ◽  
Michael A. Sargent ◽  
...  
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Clinical Success ◽  
Third Ventricle ◽  
Ventricular Volume ◽  
Third Ventriculostomy ◽  
Lamina Terminalis ◽  
The Third ◽  
Interpeduncular Cistern ◽  
Endoscopic Third Ventriculostomy Success

Object The criteria for identifying patients in whom endoscopic third ventriculostomy (ETV) provides control of hydrocephalus remain in evolution. In particular, it is not clear when ETV would be effective if intraventricular obstruction is not found preoperatively. The authors postulated that 1) displacement of the third ventricle floor inferiorly into the interpeduncular cistern and displacement of the lamina terminalis anteriorly into the lamina terminalis cistern could predict clinical success of ETV, and 2) improvement in these displacements would correlate with the success of ETV. Methods Magnetic resonance imaging in 38 consecutive patients treated between 2004 and 2010 was reviewed to assess displacement of the lamina terminalis and third ventricular floor prior to and following ETV. Displacements of the floor and lamina terminalis were judged qualitatively and quantitatively, using a newly created index, the Third Ventricular Morphology Index (TVMI). The association between the aforementioned morphological features and clinical success of ETV was analyzed. Results Ninety-six percent of patients in whom the authors preoperatively observed displacement of the lamina terminalis and the third ventricular floor were successfully treated with ETV. Displacements of the third ventricular floor and lamina terminalis, as judged qualitatively, correlated with the clinical success of ETV. The TVMI correlated with the qualitative assessments of displacement. Postoperative decrease in the TVMI occurred in the majority of successfully treated patients. Changes in third ventricular morphology preceded changes in other measures of third and lateral ventricular volume following ETV. Conclusions Assessment of third ventricular floor and lamina terminalis morphology is useful in predicting clinical success of ETV and in the follow-up in treated patients. The TVMI provided a quantitative assessment of the third ventricular morphology, which may be useful in equivocal cases and in research studies.

scholarly journals Endoscopic third ventriculostomy for treatment of adult hydrocephalus: long-term follow-up of 163 patients

2016 ◽  
Vol 41 (3) ◽  
pp. E3 ◽  
Author(s):  
Albert M. Isaacs ◽  
Yarema B. Bezchlibnyk ◽  
Heather Yong ◽  
Dilip Koshy ◽  
Geberth Urbaneja ◽  
...  
Keyword(s):  
Clinical Improvement ◽  
Treatment Modality ◽  
Endoscopic Third Ventriculostomy ◽  
Adult Patients ◽  
Third Ventriculostomy ◽  
Long Term Treatment ◽  
Patient Reported ◽  
Csf Diversion

OBJECTIVE The efficacy of endoscopic third ventriculostomy (ETV) for the treatment of pediatric hydrocephalus has been extensively reported in the literature. However, ETV-related long-term outcome data are lacking for the adult hydrocephalus population. The objective of the present study was to assess the role of ETV as a primary or secondary treatment for hydrocephalus in adults. METHODS The authors performed a retrospective chart review of all adult patients (age ≥ 18 years) with symptomatic hydrocephalus treated with ETV in Calgary, Canada, over a span of 20 years (1994–2014). Patients were dichotomized into a primary or secondary ETV cohort based on whether ETV was the initial treatment modality for the hydrocephalus or if other CSF diversion procedures had been previously attempted respectively. Primary outcomes were subjective patient-reported clinical improvement within 12 weeks of surgery and the need for any CSF diversion procedures after the initial ETV during the span of the study. Categorical and actuarial data analysis was done to compare the outcomes of the primary versus secondary ETV cohorts. RESULTS A total of 163 adult patients with symptomatic hydrocephalus treated with ETV were identified and followed over an average of 98.6 months (range 0.1–230.4 months). All patients presented with signs of intracranial hypertension or other neurological symptoms. The primary ETV group consisted of 112 patients, and the secondary ETV consisted of 51 patients who presented with failed ventriculoperitoneal (VP) shunts. After the initial ETV procedure, clinical improvement was reported more frequently by patients in the primary cohort (87%) relative to those in the secondary ETV cohort (65%, p = 0.001). Additionally, patients in the primary ETV group required fewer reoperations (p < 0.001), with cumulative ETV survival time favoring this primary ETV cohort over the course of the follow-up period (p < 0.001). Fifteen patients required repeat ETV, with all but one experiencing successful relief of symptoms. Patients in the secondary ETV cohort also had a higher incidence of complications, with one occurring in 8 patients (16%) compared with 2 in the primary ETV group (2%; p = 0.010), although most complications were minor. CONCLUSIONS ETV is an effective long-term treatment for selected adult patients with hydrocephalus. The overall ETV success rate when it was the primary treatment modality for adult hydrocephalus was approximately 87%, and 99% of patients experience symptomatic improvement after 2 ETVs. Patients in whom VP shunt surgery fails prior to an ETV have a 22% relative risk of ETV failure and an almost eightfold complication rate, although mostly minor, when compared with patients who undergo a primary ETV. Most ETV failures occur within the first 7 months of surgery in patients treated with primary ETV, but the time to failure is more prolonged in patients who present with failed previous shunts.

scholarly journals Combined microsurgical-endoscopic paramedian supracerebellar-infratentorial approach for resection of a pineal low-grade glioma

2021 ◽  
Vol 5 (1) ◽  
pp. V9
Author(s):  
Juan M. Revuelta Barbero ◽  
Roberto M. Soriano ◽  
Rima S. Rindler ◽  
David P. Bray ◽  
Oswaldo Henriquez ◽  
...  
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Third Ventricle ◽  
Pineal Region ◽  
Third Ventriculostomy ◽  
Low Grade ◽  
Total Resection ◽  
Blurred Vision ◽  
History Of ◽  
Supracerebellar Infratentorial Approach

The authors present the case of a 20-year-old male with a history of headaches and blurred vision found to have a pineal mass and chronic hydrocephalus. The patient initially underwent an endoscopic third ventriculostomy and pineal mass biopsy that revealed a low-grade neuroepithelial neoplasm. A microsurgery-endoscope–assisted paramedian supracerebellar-infratentorial approach was chosen and a gross-total resection was achieved. The patient’s postoperative and follow-up course has been unremarkable, with early postoperative imaging demonstrating no residual tumoral mass. The operative video highlights the advantages of endoscopic visualization for deep lesions in the pineal region and posterior third ventricle. The video can be found here: https://stream.cadmore.media/r10.3171/2021.4.FOCVID2119.

scholarly journals Endoscopic third ventriculostomy in adult patients

2005 ◽  
Vol 19 (6) ◽  
pp. 1-6 ◽  
Author(s):  
Amin Amini ◽  
Richard H. Schmidt
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Surgical Techniques ◽  
Adult Patients ◽  
Doppler Imaging ◽  
Third Ventriculostomy ◽  
Term Outcome ◽  
Long Term Outcome

Endoscopic third ventriculostomy (ETV) has gained popularity and has become the treatment of choice for certain pediatric and adult hydrocephalic conditions. The authors report their experience with 36 adult patients and evaluate the long-term outcome and safety of ETV. They discuss several improvements to the surgical techniques that they have developed based on their experience, including the use of intraoperative Doppler imaging before fenestration to trace the location of vessels underlying the floor of the third ventricle. They also report the use of a Rickham reservoir and endoventricular stent in selected cases and discuss the indications for their use. In cases of obstructive hydrocephalus due to congenital or acquired aqueductal stenosis in adults, the success rate of ETV in avoidance of shunt placement is 72%. Twenty-two percent of the patients in this series in whom ETV was initially successful later experienced closure of the fenestration and recurrent symptoms at a mean interval of 3.75 years. Thus, in patients who undergo this treatment, long-term periodic follow-up review should be performed.

scholarly journals Endoscopic third ventriculostomy may have long term efficacy in low birth weight preterm newborns

2013 ◽  
Vol 32 (02) ◽  
pp. 110-113
Author(s):  
Matheus Fernandes de Oliveira ◽  
Koshiro Nishikuni ◽  
José Marcus Rotta
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Endoscopic Third Ventriculostomy ◽  
Third Ventriculostomy ◽  
Term Result ◽  
Moebius Syndrome ◽  
Long Term Result ◽  
Preterm Newborns

AbstractEndoscopic third ventriculostomy (ETV) is an established treatment for hydrocephalus and is an alternative method avoiding shunts and its complications. There is still controversy regarding the higher risk of failure in younger infants. NARF was a male preterm newborn of 33 weeks old, with Moebius syndrome and 1,800 grams at birth. Detailed neonatal evaluation revealed hydrocephalus with bilateral ventricular index of 0.6. It was then decided, in spite of prematurity and low birth weight to perform ETV with the age of 25 days, with 1,850 grams. After discharge, follow-up was lost due to family moving to another city. By chance, after seven years child returned to our medical facility and a follow-up magnetic resonance revealed pervious ETV with high flow, demonstrating functionality of ventriculostomy. Patient's age and etiology of hydrocephalus are the most important factors influencing the success rate of ETV. Recently, the age between 6 months and 1 year old became a cutoff below which failure rates are reported to be particularly high and there are dichotomized experience. The results in low birth weight and preterm infants is not widely known and can be poor. Our case illustrates a successful ETV in a both preterm and low birth weight newborn and a satisfactory long term result, reinforcing the security and efficacy of ETV even in newborns.

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