scholarly journals Flow diversion of a recurrent, iatrogenic basilar tip aneurysm in a pediatric patient: case report

2018 ◽  
Vol 21 (1) ◽  
pp. 90-93 ◽  
Author(s):  
Rahul A. Sastry ◽  
Matthew J. Koch ◽  
Benjamin L. Grannan ◽  
Christopher J. Stapleton ◽  
William E. Butler ◽  
...  
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Pediatric Population ◽  
Subsequent Development ◽  
Flow Diversion ◽  
Third Ventriculostomy ◽  
Complication Rates ◽  
Traumatic Pseudoaneurysm ◽  
Noncommunicating Hydrocephalus ◽  
Basilar Tip Aneurysm ◽  
Vessel Reconstruction

Endoscopic third ventriculostomy (ETV) is a common treatment for noncommunicating hydrocephalus. Although rare, vascular injury and traumatic pseudoaneurysm development during ETV have been reported. The authors present the case of a 13-year-old boy who underwent repeat ETV (rETV) for shunt and ETV failure, and who suffered an intraoperative subarachnoid hemorrhage due to iatrogenic injury to the basilar tip, with subsequent development of a pseudoaneurysm. Despite initial primary coil embolization, the aneurysm recurred and was definitively treated with flow diversion. In this report, the authors review complication rates associated with ETV and rETV as well as the emerging use of flow diversion and its applications in vessel reconstruction within the pediatric population.

Complications of neuroendoscopic septostomy

2021 ◽  
pp. 1-7
Author(s):  
Travis J. Atchley ◽  
Blake Sowers ◽  
Anastasia A. Arynchyna ◽  
Curtis J. Rozzelle ◽  
Brandon G. Rocque
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Third Ventriculostomy ◽  
Complication Rates ◽  
Ventricular Size ◽  
Current Procedural Terminology ◽  
Operative Techniques ◽  
Chi Square ◽  
Intraoperative Complication ◽  
Significant Difference ◽  
Lower Complication

OBJECTIVE The advent of neuroendoscopy revolutionized the management of complex hydrocephalus. Fenestration of the septum pellucidum (septostomy) is often a therapeutic and/or necessary intervention in neuroendoscopy. However, these procedures are not without risk. The authors sought to record the incidence and types of complications. They attempted to discern if there was decreased likelihood of septostomy complications in patients who underwent endoscopic third ventriculostomy (ETV)/choroid plexus cauterization (CPC) as compared with those who underwent other procedures and those with larger ventricles preoperatively. The authors investigated different operative techniques and their possible relationships to septostomy complications. METHODS The authors retrospectively reviewed all neuroendoscopic procedures with Current Procedural Terminology code 62161 performed from January 2003 until June 2019 at their institution. Septostomy, either alone or in conjunction with other procedures, was performed in 118 cases. Basic demographic characteristics, clinical histories, operative details/findings, and adverse events (intraoperative and postoperative) were collected. Pearson chi-square and univariate logistic regression analyses were performed. Patients with incomplete records were excluded. RESULTS Of 118 procedures, 29 (24.5%) septostomies had either intraoperative or postoperative complications. The most common intraoperative complication was bleeding, as noted in 12 (10.2%) septostomies. Neuroendocrine dysfunction, including apnea, bradycardia, neurological deficit, seizure, etc., was the most common postoperative complication and seen after 15 (12.7%) procedures. No significant differences in complications were noted between ventricular size or morphology or between different operative techniques or ventricular approaches. There was no significant difference between the complication rate of patients who underwent ETV/CPC and that of patients who underwent septostomy as a part of other procedures. Greater length of surgery (OR 1.013) was associated with septostomy complications. CONCLUSIONS Neuroendoscopy for hydrocephalus due to varying etiologies provides significant utility but is not without risk. The authors did not find associations between larger ventricular size or posterior endoscope approach and lower complication rates, as hypothesized. No significant difference in complication rates was noted between septostomy performed during ETV/CPC and other endoscopic procedures requiring septostomy.

Rigid versus flexible neuroendoscopy: a systematic review and meta-analysis of endoscopic third ventriculostomy for the management of pediatric hydrocephalus

2021 ◽  
pp. 1-11
Author(s):  
Daphne Li ◽  
Vijay M. Ravindra ◽  
Sandi K. Lam
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Statistical Significance ◽  
Flexible Endoscopy ◽  
Third Ventriculostomy ◽  
Complication Rates ◽  
Inclusion Criteria ◽  
Related Complication ◽  
Rigid Endoscopy ◽  
Pediatric Hydrocephalus ◽  
Significant Difference

OBJECTIVE Endoscopic third ventriculostomy (ETV), with or without choroid plexus cauterization (±CPC), is a technique used for the treatment of pediatric hydrocephalus. Rigid or flexible neuroendoscopy can be used, but few studies directly compare the two techniques. Here, the authors sought to compare these methods in treating pediatric hydrocephalus. METHODS A systematic MEDLINE search was conducted using combinations of keywords: “flexible,” “rigid,” “endoscope/endoscopic,” “ETV,” and “hydrocephalus.” Inclusion criteria were as follows: English-language studies with patients 2 years of age and younger who had undergone ETV±CPC using rigid or flexible endoscopy for hydrocephalus. The primary outcome was ETV success (i.e., without the need for further CSF diversion procedures). Secondary outcomes included ETV-related and other complications. Statistical significance was determined via independent t-tests and Mood’s median tests. RESULTS Forty-eight articles met the study inclusion criteria: 37 involving rigid endoscopy, 10 involving flexible endoscopy, and 1 propensity scored–matched comparison. A cumulative 560 patients had undergone 578 rigid ETV±CPC, and 661 patients had undergone 672 flexible ETV±CPC. The flexible endoscopy cohort had a significantly lower average age at the time of the procedure (0.33 vs 0.53 years, p = 0.001) and a lower preoperatively predicted ETV success score (median 40, IQR 32.5–57.5 vs 62.5, IQR 50–70; p = 0.033). Average ETV success rates in the rigid versus flexible groups were 54.98% and 59.65% (p = 0.63), respectively. ETV-related complication rates did not differ significantly at 0.63% for flexible endoscopy and 3.46% for rigid endoscopy (p = 0.30). There was no significant difference in ETV success or complication rate in comparing ETV, ETV+CPC, and ETV with other concurrent procedures. CONCLUSIONS Despite the lower expected ETV success scores for patients treated with flexible endoscopy, the authors found similar ETV success and complication rates for ETV±CPC with flexible versus rigid endoscopy, as reported in the literature. Further direct comparison between the techniques is necessary.

Endoscopic Third Ventriculostomy for the Treatment of Hydrocephalus in a Pediatric Population with Myelomeningocele

2017 ◽  
Vol 105 ◽  
pp. 163-169 ◽  
Author(s):  
Joana Rei ◽  
Josué Pereira ◽  
Carina Reis ◽  
Sérgio Salvador ◽  
Rui Vaz
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Pediatric Population ◽  
Third Ventriculostomy

Indocyanine Green Angiography in Endoscopic Third Ventriculostomy

2013 ◽  
Vol 73 (suppl_1) ◽  
pp. ons67-ons73 ◽  
Author(s):  
Dorothee Wachter ◽  
Timo Behm ◽  
Kajetan von Eckardstein ◽  
Veit Rohde
Keyword(s):  
Indocyanine Green ◽  
Basilar Artery ◽  
Endoscopic Third Ventriculostomy ◽  
Third Ventricle ◽  
Third Ventriculostomy ◽  
The Third ◽  
Vessel Injury ◽  
Icg Angiography ◽  
Noncommunicating Hydrocephalus ◽  
Intraoperative Visualization

Abstract BACKGROUND: Endoscopic third ventriculostomy (ETV) has become a well-established method for the treatment of noncommunicating hydrocephalus with a high success rate and a relatively low morbidity rate. However, vessel injury has been repeatedly reported, often with a fatal outcome. Vessel injury is considered to be the most threatening complication. The use of indocyanine green (ICG) angiography has become an established tool in vascular microneurosurgery. OBJECTIVE: We report our initial experience with endoscopic ICG angiography in ETV for intraoperative visualization of the basilar artery and its perforators to reduce the risk of vascular injury. METHODS: Eleven patients with noncommunicating hydrocephalus underwent ETV. Before opening of the third ventricular floor, ICG angiography was performed using a prototype neuroendoscope for intraoperative visualization of ICG fluorescence. RESULTS: In 10 patients, ETV and ICG angiography were successfully performed. In 1 case, ICG angiography failed. Even in the presence of an opaque floor of the third ventricle (n = 5), ICG angiography clearly demonstrated the course of the basilar artery and its major branches and was considered useful. CONCLUSION: ICG angiography has the potential to become a useful adjunct in ETV for better visualization of vessel structures, especially in the presence of aberrant vasculature, a nontranslucent floor of the third ventricle, or in case of reoperations.

scholarly journals Hydrocephalus in children – A rare case of pineal cavernoma and literature review

2020 ◽  
Vol 11 ◽  
pp. 294
Author(s):  
Ricardo Malcata Nogueira ◽  
Luis Santos Cardoso ◽  
Lino Fonseca ◽  
Miguel Correia ◽  
Amets Iraneta ◽  
...  
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Histopathological Examination ◽  
Vascular Malformations ◽  
Pediatric Population ◽  
Pineal Region ◽  
Third Ventriculostomy ◽  
Cavernous Malformations ◽  
Lesion Studies ◽  
Visual Disturbances ◽  
The Ideal

Background: Cavernous malformations prevalence ranges from 0.4 to 0.6% and accounts for 5–15% of all central nervous system vascular malformations. Pineal cavernomas constitute <1% of all locations published in the literature, with a total of 26 cases reported, only 5 regarding the pediatric population until 2020. Overall annual hemorrhage rate is 2.4%. Symptoms are often due to hydrocephalus and intracranial hypertension. Case Description: We report a case of a 5-year-old child with visual disturbances, headache, and progressive neurologic deterioration. MR showed a lesion in the pineal region and triventricular hydrocephalus. She was submitted to endoscopic third ventriculostomy and total excision of the lesion by the infratentorial supracerebellar approach a few days later. Histopathological examination confirmed a pineal cavernous malformation. The patient returned to her normal life without any neurologic deficit and a normal development. Conclusion: The ideal treatment is primary lesion removal; however, due to the infrequency and because it is a curable lesion, studies seeking to deepen the knowledge of this disease are considered relevant.

scholarly journals Endoscopic third ventriculostomy in failed ventriculoperitoneal shunt in pediatric population

2020 ◽  
Vol 15 (4) ◽  
pp. 937
Author(s):  
Shivender Sobti ◽  
Ajay Choudhary ◽  
Sourabh Zambre ◽  
Suryanarayanan Bhaskar
Keyword(s):  
Ventriculoperitoneal Shunt ◽  
Endoscopic Third Ventriculostomy ◽  
Pediatric Population ◽  
Third Ventriculostomy

Endoscopic third ventriculostomy in patients with a diminished prepontine interval

2010 ◽  
Vol 5 (3) ◽  
pp. 250-254 ◽  
Author(s):  
Mark M. Souweidane ◽  
Peter F. Morgenstern ◽  
Sungkwon Kang ◽  
Apostolos John Tsiouris ◽  
Jonathan Roth
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Third Ventricle ◽  
Patient Characteristics ◽  
Third Ventriculostomy ◽  
Technical Success ◽  
Imaging Studies ◽  
Entire Cohort ◽  
Patient Morbidity ◽  
Noncommunicating Hydrocephalus ◽  
Historical Controls

Object Fenestration of the floor of the third ventricle is vital to the success of endoscopic third ventriculostomy (ETV) in treating patients with noncommunicating hydrocephalus. A generous prepontine interval (PPI) is generally accepted as one anatomical feature that may affect the safety and functionality of ETV. Whether a diminished PPI influences the safety or success of ETV, however, has not been adequately assessed. Methods A review was conducted on the last 100 ETV procedures performed by the first author (M.M.S.). From archived preoperative MR imaging studies, the PPI was measured between the dorsum sellae and the basilar artery. For any patient with an interval of ≤1 mm, the technical and functional success of the procedure was recorded. Technical success was defined when a surgically created fenestration was accomplished without patient morbidity. Functional success was defined as the patient not needing any additional CSF diversionary procedure within 3 months after ETV. Results In the entire cohort, the PPI ranged from 0 to 9.5 mm (mean 3.2 mm). There were 15 procedures performed in patients with a PPI of ≤1 mm. In all 15 procedures, a fenestration of the tuber cinereum was accomplished without vascular injury or patient morbidity. The ETV was successful in 11 patients (73.3%). All 4 failures occurred in children who had surgery during infancy (mean age 11 months). Conclusions Patients with an obliterated or reduced PPI can safely undergo ETV. The functional success rate appears equivalent to historical controls. Most failures in this series may be attributed to other patient characteristics, namely young age at the time of ETV.

Endoscopic Third Ventriculostomy

Neurosurgery ◽  
1990 ◽  
Vol 26 (1) ◽  
pp. 86-92 ◽  
Author(s):  
R. F. C. Jones ◽  
W. A. Stening ◽  
M. Brydon
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Late Onset ◽  
Surgical Techniques ◽  
Rapid Onset ◽  
Third Ventriculostomy ◽  
Significant Morbidity ◽  
Cerebrospinal Fluid Diversion ◽  
Noncommunicating Hydrocephalus ◽  
Chiari Malformations

Abstract Long-term extracranial shunting for hydrocephalus has numerous drawbacks related to shunt malfunction and infection. In some cases outcome has been very disappointing. We successfully managed 5 patients with acquired aqueductal stenoses with no significant morbidity by the use of an intracranial cerebrospinal fluid diversion, namely a third ventriculostomy. First advocated by Dandy, ventriculostomy was largely passed over in favor of extracranial procedures. With improved surgical techniques, however, ventriculostomy is now considered to be a viable alternative in selected cases. In a further 19 patients, we subsequently broadened our patient selection to include those with Arnold-Chiari malformations, congenital noncommunicating hydrocephalus, and tumors. Two thirds of these children remain without shunts and apart from 1 child developing hemiplegia postoperatively, there has been no significant morbidity. Although the best results have been seen in the late onset groups, even early onset, noncommunicating hydrocephalus has been successfully managed. Even in patients in whom third ventriculostomy has failed and who have subsequently required ventriculoperitoneal shunts, we anticipate that they will remain less dependent on shunts because their hydrocephalus is now communicating, which tends not to have such a rapid onset or extreme levels of raised intracranial pressure. (Neurosurgery 26:86-92, 1990)

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