Repeated endoscopic third ventriculostomy (ETV). Role of advanced instruments for performing this minimally invasive surgery

This series of studies presents the results of repeated endoscopic third ventriculostomy (ETV) in patients with occlusive hydrocephalus. 33 cases of repeated ETV were considered as a material for the study: 7 adult patients aged 18 years and older (19 % (3 men, 4 women)) and 26 children aged 0 to 17 years (81 % (15 boys, 11 girls)). The average period of clinical observation after the surgery was 42,3 ± 2,7 months. 21 patients (64 %) had the effect from the surgery, they became shunt-independent. 23 repeated endoscopic third ventriculostomy were performed using standard rigid endoscopes (Gaab, Lotta, Little Lotta Endoscopes), the other 10 surgeries were performed using miniature semi-rigid needle endoscope. There were no postoperative neurological, endocrine and infectious complications in the studied group.

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Endoscopic third ventriculostomy for shunt dysfunction in occlusive hydrocephalus: long-term follow up and review

Journal of Neurosurgery ◽

10.3171/jns.2003.98.5.1032 ◽

2003 ◽

Vol 98 (5) ◽

pp. 1032-1039 ◽

Cited By ~ 89

Author(s):

Jürgen Boschert ◽

Dieter Hellwig ◽

Joachim K. Krauss

Keyword(s):

Endoscopic Third Ventriculostomy ◽

Obstructive Hydrocephalus ◽

The Other ◽

Third Ventriculostomy ◽

Content Type ◽

Shunt Placement ◽

Occlusive Hydrocephalus ◽

Shunt Dysfunction ◽

Fine Print

Object. Endoscopic third ventriculostomy (ETV) is the treatment of choice for occlusive (noncommunicating) hydrocephalus. Nevertheless, its routine use in patients who have previously undergone shunt placement is still not generally accepted. The authors' aim was to investigate the long-term effects of ETV in a group of prospectively chosen patients. Methods. Patients who underwent ETV and had previously undergone shunt placement for occlusive hydrocephalus were followed prospectively for at least 3 years (range 36–103 months, mean 63.6 months). Nine female and eight male patients ranging from 8 to 54 years of age (mean 32 years) had undergone shunt placement 0.7 to 23.5 years (mean 8.1 years) before ETV. Fifteen patients were admitted with underdrainage and two with overdrainage. In six cases, ETV was performed as an emergency operation. The origin of hydrocephalus was aqueductal stenosis in 12 cases and aqueductal compression by a tumor in two cases. Three patients suffered from a fourth ventricle outlet syndrome, and in two patients an additional malresorptive component was suspected. Thirteen patients underwent ETV with shunt removal and insertion of an external drain in one session. The drain served as a safety measure; it could be opened if raised intracranial pressure or ventricular dilation was observed on postoperative imaging studies. In the other four patients the shunt was initially ligated and then removed during a second operation. Fourteen patients (82%) have remained shunt free. The other three patients, including the two with an additional malresorptive component, needed shunt reimplantation 3 days, 2 weeks, or 7 months after ETV. Conclusions. Use of ETV is safe and effective for the treatment for shunt dysfunction in patients with obstructive hydrocephalus.

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