scholarly journals Endoscopic third ventriculostomy and choroid plexus cauterization in infant hydrocephalus: a prospective study by the Hydrocephalus Clinical Research Network

2018 ◽  
Vol 21 (3) ◽  
pp. 214-223 ◽  
Author(s):  
Abhaya V. Kulkarni ◽  
Jay Riva-Cambrin ◽  
Curtis J. Rozzelle ◽  
Robert P. Naftel ◽  
Jessica S. Alvey ◽  
...  
Keyword(s):  
Prospective Study ◽  
Failure Rate ◽  
Intraventricular Hemorrhage ◽  
Endoscopic Third Ventriculostomy ◽  
Treatment Success ◽  
Aqueductal Stenosis ◽  
Research Network ◽  
Third Ventriculostomy ◽  
Matched Pairs ◽  
A Prospective Study

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.

scholarly journals Longstanding overt ventriculomegaly in adults: pitfalls in treatment with endoscopic third ventriculostomy

2007 ◽  
Vol 22 (4) ◽  
pp. 1-6 ◽  
Author(s):  
Harold L. Rekate
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Short Term Memory ◽  
Treatment Success ◽  
Aqueductal Stenosis ◽  
Third Ventriculostomy ◽  
Success Rates ◽  
Venous Stenting ◽  
Mild Degree ◽  
Secondary Phenomenon ◽  
Triventricular Hydrocephalus

Object The recently described condition of longstanding overt ventriculomegaly in adults (LOVA) has not been defined in terms of the need for intervention, timing of intervention, and ideal treatment. The purpose of this review was to evaluate the role of endoscopic third ventriculostomy (ETV) in the treatment of LOVA. Methods Data collected in six patients with LOVA who had undergone ETV were reviewed retrospectively in terms of the definition of treatment success, rates of success, complications, and outcome. All six patients presented with headache disorders. In all patients, triventricular hydrocephalus had been diagnosed as aqueductal stenosis, and head circumference measurements were above the 98th percentile. All six had undergone successful ETV as documented by the free flow of cerebrospinal fluid into the basal cisterns, which remained open throughout the follow-up period. After the procedure, one patient experienced a mild degree of difficulty with short-term memory. Five patients remained symptomatic or had symptoms requiring further treatment 3 months to 3 years after ETV. Four patients received ventriculoperitoneal shunts, and one underwent venous stenting for high intracranial pressure after successful ETV. In two patients in whom aqueductal stenosis had been diagnosed, the sylvian aqueduct was patent after the procedure. Conclusions In LOVA patients who present with headaches, ETV may not lead to improvement in the headaches. Despite the presence of triventricular hydrocephalus, closure of the aqueduct may be a secondary phenomenon, and flow through the aqueduct may be reestablished after ETV. If intracranial hypertension persists after successful ETV, its cause may be increased venous sinus pressure.

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.

Relationship Between Pressure Passivity and Subependymal/Intraventricular Hemorrhage as Assessed by Pulsed Doppler Ultrasound

PEDIATRICS ◽  
1983 ◽  
Vol 72 (5) ◽  
pp. 665-669
Author(s):  
Peter A. Ahmann ◽  
Francine D. Dykes ◽  
Anthony Lazzara ◽  
Philip J. Holt ◽  
Don P. Giddens ◽  
...  
Keyword(s):  
Prospective Study ◽  
Doppler Ultrasound ◽  
Intraventricular Hemorrhage ◽  
Anterior Cerebral Artery ◽  
The Other ◽  
Passive State ◽  
Pulsed Doppler ◽  
Noninvasive Technique ◽  
Pulsed Doppler Ultrasound ◽  
A Prospective Study

A prospective study was undertaken using a range-gated, pulsed Doppler velocimeter to study flowpressure relationships in the anterior cerebral artery. Serial velocity and pressure studies were performed with each infant serving as his or her own control. The hypothesis tested was that ill preterm infants sustaining subependymal/intraventricular hemorrhage would have absent autoregulation. The hypothesis has been tested in 88 studies on 32 infants. Of 32 infants studied, 15 were judged to be pressure passive; nine of these children bled. The other 17 infants were not pressure passive; eight of these children bled (P &gt; .05). From these studies, it may be concluded that the pressure passive state is not the final common link in the genesis of subependymal/intravertricular hemorrhage. Pulsed Doppler ultrasound may provide an extremely useful noninvasive technique for studing both the arterial and venous sides of the cerebral circulation.

Treatment strategies for hydrocephalus related to Dandy-Walker syndrome: evaluating procedure selection and success within the Hydrocephalus Clinical Research Network

2021 ◽  
pp. 1-9
Author(s):  
Aaron M. Yengo-Kahn ◽  
John C. Wellons ◽  
Todd C. Hankinson ◽  
Jason S. Hauptman ◽  
Eric M. Jackson ◽  
...  
Keyword(s):  
Clinical Research ◽  
Treatment Success ◽  
Treatment Strategies ◽  
Research Network ◽  
Csf Shunt ◽  
Third Ventriculostomy ◽  
Separate Analysis ◽  
Complication Rates ◽  
Primary Analysis ◽  
Clinical Research Network

OBJECTIVE Treating Dandy-Walker syndrome–related hydrocephalus (DWSH) involves either a CSF shunt-based or endoscopic third ventriculostomy (ETV)–based procedure. However, comparative investigations are lacking. This study aimed to compare shunt-based and ETV-based treatment strategies utilizing archival data from the Hydrocephalus Clinical Research Network (HCRN) registry. METHODS A retrospective review of prospectively collected and maintained data on children with DWSH, available from the HCRN registry (14 sites, 2008–2018), was performed. The primary outcome was revision-free survival of the initial surgical intervention. The primary exposure was either shunt-based (i.e., cystoperitoneal shunt [CPS], ventriculoperitoneal shunt [VPS], and/or dual-compartment) or ETV-based (i.e., ETV alone or with choroid plexus cauterization [CPC]) initial surgical treatment. Primary analysis included multivariable Cox proportional hazards models. RESULTS Of 8400 HCRN patients, 151 (1.8%) had DWSH. Among these, the 102 patients who underwent shunt placement (79 VPSs, 16 CPSs, 3 other, and 4 multiple proximal catheter) were younger (6.6 vs 18.8 months, p < 0.001) and more frequently had 1 or more comorbidities (37.3% vs 14.3%, p = 0.005) than the 49 ETV-treated children (28 ETV-CPC). Fifty percent of the shunt-based and 51% of the ETV-based treatments failed. Notably, 100% (4/4) of the dual-compartment shunts failed. Adjusting for age, baseline ventricular size, and comorbidities, ETV-based treatment was not significantly associated with earlier failure compared with shunt-based treatment (HR for failure 1.32, 95% CI 0.77–2.26; p = 0.321). Complication rates were low: 4.9% and 6.1% (p = 0.715) for shunt- and ETV-based procedures, respectively. There was no difference in survival between ETV-CPC– and ETV-based treatment when adjusting for age (HR for failure 0.86, 95% CI 0.29–2.55, p = 0.783). CONCLUSIONS In this North American, multicenter, prospective database review, shunt-based and ETV-based primary treatment strategies of DWSH appear similarly durable. Pediatric neurosurgeons can reasonably consider ETV-based initial treatment given the similar durability and the low complication rate. However, given the observational nature of this study, the treating surgeon might need to consider subgroups that were too small for a separate analysis. Very young children with comorbidities were more commonly treated with shunts, and older children with fewer comorbidities were offered ETV-based treatment. Future studies may determine preoperative characteristics associated with ETV treatment success in this population.

scholarly journals The comparative effectiveness of ventricular shunt placement versus endoscopic third ventriculostomy for initial treatment of hydrocephalus in infants

2014 ◽  
Vol 13 (3) ◽  
pp. 295-300 ◽  
Author(s):  
Sarah C. Jernigan ◽  
Jay G. Berry ◽  
Dionne A. Graham ◽  
Liliana Goumnerova
Keyword(s):  
Intraventricular Hemorrhage ◽  
Endoscopic Third Ventriculostomy ◽  
Hierarchical Regression ◽  
Third Ventriculostomy ◽  
Failure Rates ◽  
Shunt Placement ◽  
Patient Demographics ◽  
Initial Surgery ◽  
Surgical Failure ◽  
Csf Diversion

Object The purpose of this study was to compare the effectiveness of CSF diversion with endoscopic third ventriculostomy (ETV) versus shunt therapy in infants with hydrocephalus. Methods The authors conducted a retrospective analysis of 5416 infants 1 year of age or younger with hydrocephalus (congenital or acquired) in whom CSF diversion was performed using either ETV or shunt placement at 41 children's hospitals between 2004 and 2009. Data were obtained from the Pediatric Health Information Systems database. Surgical failure was defined as the need for a repeat diversion operation within 1 year of initial surgery. The authors compared failure rates of ETV and shunt, as well as patient demographics and clinical characteristics, using hierarchical regression according to treatment group. Results During the period examined, 872 infants (16.1%) initially underwent ETV and 4544 (83.9%) underwent ventricular shunt placement. The median infant age was 37 days (IQR 11–122 days) for both ETV and shunt placement. More infants who underwent ETV rather than shunt placement were born prematurely (41.6% vs 23.9%, respectively; p < 0.01) and had intraventricular hemorrhage (45.4% vs 17.5%, respectively; p < 0.01). Higher operative failure rates at 1 year were observed in infants who underwent ETV as opposed to shunt surgery (64.5% vs 39.6%, respectively; OR 2.9 [95% CI 2.3–3.5], p < 0.01). After controlling for prematurity, intraventricular hemorrhage, and spina bifida, ETV remained associated with a higher risk of failure (OR 2.6 [95% CI 2.1–3.2]). Conclusions In infants with hydrocephalus, a greater 1-year CSF diversion failure rate may occur after ETV compared with shunt placement. This risk is most significant for procedures performed within the first 90 days of life. Further investigation of the need for multiple reoperations, cost, and impact of surgeon and hospital experience is necessary to distinguish which treatment is more effective in the long term.

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