Endoscopic third ventriculostomy for obstructive hydrocephalus

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.

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ENDOSCOPIC THIRD VENTRICULOSTOMY (ETV) IS A BETTER ALTERNATIVE FOR VP SHUNT FAILURE IN NON-COMMUNICATING HYDROCEPHALUS

10.36106/ijar/9302582 ◽

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.

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Efficacy and Safety of Endoscopic Third Ventriculostomy in Obstructive Hydrocephalus

Nepal Journal of Neuroscience ◽

10.3126/njn.v14i2.19700 ◽

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

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Outcome of Endoscopic third Ventriculostomy for Obstructive Hydrocephalus due to Posterior Fossa Lesions

Eastern Green Neurosurgery ◽

10.3126/egn.v2i1.27453 ◽

2020 ◽

Vol 2 (1) ◽

pp. 3-6

Author(s):

Suresh Sapkota ◽

Shikher Shrestha ◽

Suresh Bishokarma ◽

Suraj Thulung ◽

Bibhusan Kalu ◽

...

Keyword(s):

Posterior Fossa ◽

Endoscopic Third Ventriculostomy ◽

Obstructive Hydrocephalus ◽

Symptomatic Improvement ◽

Third Ventriculostomy ◽

Shunt Insertion ◽

Old Patients ◽

Female Ratio ◽

Visual Symptoms ◽

Csf Leakage

Background and purpose: Obstructive hydrocephalus can be treated with External ventricular Drainage (ETV), Ventriculo peritoneal shunt insertion, upfront tumor removal without cerebrospinal fluid diversion procedures or more recently ETV. Aim of our study was to study the outcome of ETV in treating such patients. Material and method: Descriptive observational study conducted at Upendra Devkota Memorial Institute Of Neurological and Allied Sciences from Sep 2015 to may 2017. Result: Twenty-three patients met the inclusion criteria. Among which, 14 (39%) patients were male with male to female ratio of 1.55. We included wide age range from 3 years to 68 years. Seven patients (30.4%) were less than 10 years while 6 patients (23%) were above 60 years old. Patients with Posterior fossa presented with varied symptoms. Ten patients (43.4%) presented with decreased level of consciousness, 14 (60.8%) presented with visual symptoms, 17 (73.9%) presented with vomiting and 23 (100%) presented with headache (Figure. 3). Visual acuity was normal among 3 (13%), decreased among 11 (48%) and with no perception of light among 3 (13%). However, acuity was not assessed among 6 (26%) patients (Figure 4).Funduscopic evaluation revealed papilledema among 20 (87%) patients while secondary optic atrophy among 3 (13%) patients. Patients were evaluated in follow up for symptomatic improvement. Consciousness were improved among 8 (80%) patients, visual symptoms improved among 10 (71.4%) patients, vomiting subsided among 15 (88.2%) patients while headache improved among 100%. Following ETV, 5 (21.7%) patients developed complications, 3 (13%) patients had intraventricular bleeding while 2 (8.6%) patients had CSF leakage from the wound. Conclusion: Endoscopic third ventriculostomy is a relatively safe and valid option for treatment obstructive hydrocephalus due to posterior fossa lesions.

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Result of Endoscopic Third Ventriculostomy for Hydrocephalus Caused by Cerebral Aqueductal Stenosis in Infant Patients

Indian Journal of Neurosurgery ◽

10.1055/s-0037-1607053 ◽

2017 ◽

Vol 06 (03) ◽

pp. 189-197 ◽

Cited By ~ 2

Author(s):

Forhad Chowdhury ◽

Mohammod Haque ◽

Khandkar Kawsar ◽

Mainul Sarker ◽

Abdul Fazal Mohammod Haque

Keyword(s):

Success Rate ◽

Clinical Improvement ◽

Postoperative Period ◽

Endoscopic Third Ventriculostomy ◽

Obstructive Hydrocephalus ◽

Aqueductal Stenosis ◽

Csf Leak ◽

Third Ventriculostomy ◽

Age Group ◽

Management Options

Background Endoscopic third ventriculostomy (ETV) is one of the important management options for hydrocephalus, especially obstructive hydrocephalus. The result of ETV in different age and etiology is quite variable according to the different authors. The study was carried out to assess the success rate of ETV as a treatment for this type of hydrocephalus in infant age group. Material and Methods The study was done prospectively on infants (age ≤ 12 months) admitted in the period from January 2009 to June 2013 suffering from obstructive hydrocephalus due to cerebral aqueductal stenosis (CAS). After making the diagnosis, we counseled the patient party about the probability of high failure rate of ETV in this age group and probable necessity of a second operation. With the informed consent, we performed ETV in these cases and followed up regularly in postoperative period. Control neuroimaging studies were done whenever needed (suspected failure of ETV and suspected stomal block). Results Total 17 infants were studied. Average follow-up was 18.7 months. Twelve infants were between the age group of six and under six months while five were above six months to one year old. Fourteen (82.35%) out of 17 patients showed overall clinical improvement. Clinical improvement was seen in two (66.6%) infants aged 2 months or younger, three (75%) aged 2+ to 3 months, five (100%) aged 3+ to 6 months, and four (80%) aged 6+ months to 1 year. Two patients had bleeding during surgery. Three developed CSF leak through the burr hole. In one case (the patient's age was 2 months), the stoma was found blocked, and hydrocephalus returned 9 weeks after ETV. In two patients, in whom VP shunt was needed, “failed ETV” was obvious in early postoperative period. In this series, average ETV success score (ETVSS) was 52.35 (range: 40–70) and overall success rate was 82.35%. This indicates that ETVSS does not correlate with the outcome of ETV in infants with CAS. Conclusion Outcome of ETV for hydrocephalus from CAS in infant is quite good and ETVSS does not correlate with the outcome.

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

Neurosurgical FOCUS ◽

10.3171/foc.2005.19.6.9 ◽

2005 ◽

Vol 19 (6) ◽

pp. 1-4 ◽

Cited By ~ 48

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.

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Endoscopic Third Ventriculostomy in Previously Shunted Children

Minimally Invasive Surgery ◽

10.1155/2013/584567 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 6

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.

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

Sinir Sistemi Cerrahisi Dergisi ◽

10.54306/sscd.2021.08760 ◽

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.

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Frequency and Pattern of Early Complications after Endoscopic Third Ventriculostomy in Obstructive Hydrocephalus

Pakistan Journal Of Neurological Surgery ◽

10.36552/pjns.v24i3.466 ◽

2020 ◽

Vol 24 (3) ◽

Author(s):

MUHAMMAD ANWAR ULLAH ◽

FAHIM ULLAH KHAN ◽

MUHAMMAD USMAN ◽

MOHAMMAD ISHAQ ◽

ZAHID KHAN

Keyword(s):

Wound Infection ◽

General Anesthesia ◽

Patient Population ◽

Endoscopic Third Ventriculostomy ◽

Obstructive Hydrocephalus ◽

Csf Leak ◽

Hospital Death ◽

Third Ventriculostomy ◽

Early Complications ◽

Frequency Pattern

Objective: To determine the frequency, pattern and outcome of early complications after endoscopic third ventriculostomy (ETV) in Obstructive hydrocephalus. Material and Methods: The study included 160 patients from Neurosurgery department, Lady Reading Hospital Peshawar and private clinics over a period of twelve months. After performing ETV under general anesthesia by a single expert neurosurgeon, the patients were followed up for seven days post operatively for the CSF leak, wound infection, meningitis, seizures, bleeding and in hospital death. Results: Eighty five percent of the patients had no untoward complications, while 15% showed complications including CSF leak (5%), wound infection (3%), meningitis (2%), seizures (2%), bleeding (2%) and in hospital death (1%). Conclusion: Due to the less invasive nature, endoscopic third ventriculostomy is favored for treating obstructive hydrocephalus in select patient population as it is safe and have better outcomes.

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Ventriculoperitoneal Shunt versus Endoscopic Third Ventriculostomy in the treatment of Obstructive Hydrocephalus in Pediatric Midline Posterior Fossa tumors

QJM ◽

10.1093/qjmed/hcab108.011 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Mohammed Tarek ◽

Hamdy Ibrahim ◽

H Jalalod'din ◽

SR Tawadros

Keyword(s):

Posterior Fossa ◽

Ventriculoperitoneal Shunt ◽

Endoscopic Third Ventriculostomy ◽

Obstructive Hydrocephalus ◽

Clinical Findings ◽

Third Ventriculostomy ◽

Posterior Fossa Tumors ◽

Shunt Insertion ◽

Vp Shunt ◽

Csf Diversion

Abstract Background Treatment of secondary hydrocephalus due to posterior fossa tumors in these children is still a matter of controversy, although preoperative ventriculo-peritoneal shunt (VP shunt) insertion before tumor excision is widely accepted among neurosurgeons but many attempts are rising to minimize permanent VP shunt insertion and associated complications and introducing third endoscopic ventriculostomy (ETV) as one of the options of 2ry hydrocephalus. Objectives Comparing the post-operative clinical success with resolution of the manifestations and post-operative complications between endoscopic third ventriculostomy and ventriculoperitoneal shunt as different modes of CSF diversion in children with 2ry hydrocephalus due to midline posterior fossa tumors. Methods The following electronic databases were searched from June 2009 to june2019: PubMed, Google scholar search engine. Cochrane database of systematic reviews, EMBASE and science Direct, using the keywords ―hydrocephalus; posterior fossa tumors; pediatrics; ventriculoperitoneal shunt; endoscopic third ventriculostomy‖. Studies were eligible if they contain the target keywords in title or abstract, addressing the Pediatric age group with 2ry hydrocephalus due to de novo posterior fossa tumor manifested by signs of increase the intra cranial tension including persistent headache and vomiting, blurred vision, 6th nerve palsy, papilledema in fundus examination, acute DCL and 2ry hydrocephalus confirmed by brain imaging. Exclusion criteria included studies including age group below 1yr or above 18 yr, or patients with recurrent post fossa tumors and operated before or patients presented by failed previously attempt of CSF diversion. Results: A total of 1255 citations were screened for eligibility,6 studies were included in our systematic review discussing, comparing and evaluating the durability of ETV versus VP shunt in treatment the 2ry hydrocephalusdue to pediatric posterior fossa tumor.. Overall study population reached 474 patients. the overall clinical findings at presentation and postoperative outcomes regarding the clinical findings improvement, radiological improvement and postoperative complications between ETV and VP shunt are compared and showing that ETV should be considered as an alternative procedure to VP shunt in controlling severe hydrocephalus related to posterior fossa tumors to relieve symptoms quickly during the preoperative period when patients should wait for their definite tumor excision. Conclusion The shorter duration of surgery, the lower incidence of morbidity, the absence of mortality, the lower incidence of procedure failure of endoscopic third ventriculostomy as compared to ventriculoperitoneal shunt, and the significant advantage of not becoming shunt dependent make endoscopic third ventriculostomy to be recommended as the first choice in the treatment of pediatric patients with marked obstructive hydrocephalus due to posterior fossa tumors. It is a preliminary, simple, safe, effective, physiological, minimally invasive procedure for the relief of elevated intracranial pressure before direct tumor removal.

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Early Outcome of Endoscopic Third Ventriculostomy With or Without Choroid Plexus Cauterization and Ventriculoperitoneal Shunt as Primary Treatment of Hydrocephalus in Infants With Myelomeningocele

Neurosurgery ◽

10.1093/neuros/nyz310_347 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Bamidele O Adebayo ◽

Okezie Kanu ◽

Olufemi B Bankole ◽

Omotayo Ojo

Keyword(s):

Success Rate ◽

Choroid Plexus ◽

Ventriculoperitoneal Shunt ◽

Endoscopic Third Ventriculostomy ◽

Successful Outcome ◽

Csf Leak ◽

Third Ventriculostomy ◽

Prospective Longitudinal ◽

Choroid Plexus Cauterization

Abstract INTRODUCTION Myelomeningocele is associated with hydrocephalus in 35% to 90% of cases. Hydrocephalus is usually treated with insertion of ventriculoperitoneal shunt. However, endoscopic third ventriculostomy with or without choroid plexus cauterization is a viable alternative. METHODS A prospective longitudinal study from January 2016 to December 2018 on patients with myelomeningocele who presented to Lagos University Teaching Hospital, Nigeria and who had hydrocephalus.Informed consent for research and surgery were obtained. ETV with or without CPC or VPS was done with general anesthesia using standard operative techniques. Patients were followed up monthly for at least 6 mo. The surgery was adjudged failed if there was progressive head enlargement as well as other signs of hydrocephalus necessitating another surgery for hydrocephalus. RESULTS A total of 48 patients completed the study. A total of Six patients were lost to follow-up. Age range of the patients was 1 to 44 wk. A total of Five patients had ETV, 21 had ETV/CPC, and 22 patients had VPS. The mean OFC at the time of surgery were 45.3 cm and 44.9 cm for the endoscopic and VPS arms respectively. There were 2 (7.6%) cases of CSF leak in the endoscopic arm and 3 (13.6%) cases of wound dehiscence, with 1 (4.5%) case of CSF leak in the VPS arm. Mean age at surgery for ETV/CPC arm was 12.3 wand 11.5 wk for the VPS arm. Mean time to failure was 9.9 and 6.3 wk for endoscopic and VPS arms respectively. Four (80%) of the patients who had ETV had a successful outcome, 11 (52.3%) of those who had ETV/CPC had a successful outcome and 13 (59%) of those who had VPS had a successful outcome. At 6 mo follow up, overall success rate for the endoscopic arm was 57.6% and 59% for the VPS. CONCLUSION Endoscopic third ventriculostomy with or without choroid plexus cauterization had similar success rate with VPS at 6 mos.

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