scholarly journals Clinical Impact of the Patient Age Following Endoscopic Third Ventriculostomy: A Review

2021 ◽  
Vol 11 (12) ◽  
pp. 188-196
Author(s):  
Dipak Chaulagain ◽  
Volodymyr Smolanka ◽  
Andriy Smolanka
Keyword(s):  
Patient Selection ◽  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
Third Ventriculostomy ◽  
Endoscopic Stenting ◽  
Patient Age ◽  
Disease Etiology ◽  
Endoscopic Techniques ◽  
Patient Âgé ◽  
Neurosurgical Patients

Background: Clinically erratic cerebrospinal fluid (CSF) outflow within brain ventricles was described as non-communicating and communicating hydrocephalous. Neurosurgical patients are commonly seen with increased intracranial pressure due to increased CSF accumulation. (1) Initially scientists followed ventriculoperitoneal shunt an inexpensive and available technique to treat hydrocephalous disorders. Due to least successful outcomes, Scientists used other alternative endoscopic techniques. These endoscopic techniques include aqueductal endoscopic stenting, aqueductoplasty and third ventriculostomy (2). Defining success rate of Endoscopic third ventriculostomy clinical and radiographic analysis are considered gold standard. Objectives: Our review aims to assess comparative role of patient age, patient selection, hydrocephalus etiology, surgical advancement and epigenetic treatment strategies following endoscopic third ventriculostomy focusing hydrocephalous. The main objectives of current study, to critically analyze available literature till to date and a step forward for the development of standard surgical protocols. Methodology: Clinical studies from Level I-IV published in English language focusing human subject only were only considered by retrieving NCBI/PubMed, Medline databases. Studies purely focusing third ventriculostomy in subject of patient age, hydrocephalus etiology and age associated complications were processed further. Objective based data inspection approach was followed. From each included study focusing third ventriculostomy detailed information demographic information was collected. Further data analysis was done by using SAS and multiple tools of Microsoft Excel Version 2010. Outcomes: From total 11 included studies specifically focusing hydrocephaly treatment via endoscopic third ventriculostomy, 757 patients with equal 1:1 male and female gender ratio and 125 cases of unknown gender were considered. Current study highlighting efficacy of Endoscopic third ventriculostomy at the rate of 77% effective treating obstructive hydrocephalus. On basis of etiological concerns about 36.32 % cases hydrocephalous cases were linked with encephalitis, underweight birth and nonspecific etiology. However, 24 % cases of hydrocephalus were led by group of tumors including, Ependymoma, Medulloblastoma, Meningioma, Cerebella pontine angle Tumors and Pineal gland carcinomas as well. 154 (20%) cases of obstructive hydrocephalus were associated with aqueduct stenosis, 16% cases reporting hemorrhage and only 23 cyst cases. Conclusion and future recommendations: Endoscopic third ventriculostomy (ETV) is a safe and effective (77%) treatment option for the treatment of obstructive hydrocephalus among all age groups. However, specifically highest efficacy was noted among patients of 15-30-year age group. Understanding disease etiology and patient selection criteria both are considered potential components following successful endoscopic third ventriculostomy. We highly recommend further research following a universal age criteria and reporting results in distinct age category to standardize ETV treating hydrocephaly efficiently. Key words: Endoscopic third ventriculostomy, ETV, hydrocephalous, aqueductal endoscopic stenting, aqueductoplasty.

ENDOSCOPIC THIRD VENTRICULOSTOMY IN IDIOPATHIC NORMAL PRESSURE HYDROCEPHALUS

Neurosurgery ◽  
2008 ◽  
Vol 63 (1) ◽  
pp. 62-69 ◽  
Author(s):  
ichelangelo Gangemi ◽  
Francesco Maiuri ◽  
Michele Naddeo ◽  
Umberto Godano ◽  
Carmelo Mascari ◽  
...  
Keyword(s):  
Clinical Improvement ◽  
Normal Pressure Hydrocephalus ◽  
Endoscopic Third Ventriculostomy ◽  
Clinical History ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Third Ventriculostomy ◽  
Patient Age ◽  
Clinical Onset ◽  
Patient Âgé

ABSTRACT OBJECTIVES The aim of the report is to define the indications and results of endoscopic third ventriculostomy (ETV) in idiopathic normal pressure hydrocephalus and to discuss the physiopathological mechanism of this procedure. METHODS The cases of 110 patients with idiopathic normal pressure hydrocephalus who underwent ETV in four Italian neurosurgical centers were retrospectively reviewed. The postoperative outcome was correlated with patient age, length of clinical history, preoperative clinical score, symptoms of clinical onset, type of hydrocephalus, and intraoperative findings. RESULTS The follow-up period ranged from 2 to 12 years (average, 6.5 yr). The outcome evaluation was made 2 years after the procedure. Postoperative clinical improvement occurred in 76 (69.1%) of 110 patients. There was no correlation between success rate and patient age or type of ventricular enlargement (normal or enlarged fourth ventricle). Conversely, the rate of neurological improvement was higher in patients with shorter clinical history, better preoperative neurological score, and clinical onset with gait disturbances. Moreover, the intraoperative finding of the sudden reappearance of normal cerebral pulsations and significant downward and upward movements of the third ventricular floor after ETV was also correlated with a good outcome. CONCLUSION ETV results in a relatively high rate of clinical improvement and a low complication rate in patients with idiopathic normal pressure hydrocephalus. Therefore, it may be easily performed with the same approach used for intracranial pressure monitoring with low morbidity. However, our data must be confirmed by additional studies.

Endoscopic third ventriculostomy in patients younger than 2 years: outcome analysis of 41 hydrocephalus cases

2010 ◽  
Vol 5 (4) ◽  
pp. 392-401 ◽  
Author(s):  
Albert A. Sufianov ◽  
Galina Z. Sufianova ◽  
Iurii A. Iakimov
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Third Ventricle ◽  
Negative Relationship ◽  
Third Ventriculostomy ◽  
Patient Age ◽  
The Third ◽  
Patient Âgé ◽  
Significant Difference ◽  
Effective Procedures

Object The object of this study was to analyze the outcome of endoscopic third ventriculostomy (ETV) in patients under 2 years of age and investigate factors related to ETV success or failure in this patient population. Methods The authors reviewed their experience in using endoscopic third ventriculostomy (ETV) in the treatment of 41 hydrocephalus patients younger than 2 years. The mean duration of follow-up was 45 months. The relationship between ETV efficacy and the following variables was analyzed: cause of hydrocephalus, level of CSF occlusion, primary versus secondary ETV, type of surgical procedure, head circumference, patient age at ETV, patient age at first manifestation of hydrocephalus, and anatomical features of the ventricle. Success of ETV was assessed based on the results of neurological examination and postoperative imaging during the follow-up period. Results The authors performed 32 primary ETVs and 10 secondary ETVs (ETV after hydrocephalus surgery) in 41 patients (a second ETV was performed in 1 patient). The success rates of primary and secondary ETV were 75.8 and 55.6%, respectively (no significant difference, p = 0.15). The ETV was clinically and radiologically successful in 30 (71.4%) of 42 procedures during a mean (± SD) follow-up period of 45.0 ± 4.8 months (range 12–127 months). A negative relationship was found between success of ETV and the thickness of the floor of the third ventricle (the most effective procedures were those in which the floor of the ventricle was thinnest [p < 0.05]). There was a highly significant correlation between ETV success and prolapse of the ventricle floor (p < 0.001). Also, there was an inverse relationship between ventricle floor thickness and the width of the third ventricle (p < 0.005). In our group of patients there was significant correlation between ETV success and patient age at onset of hydrocephalus (the most effective procedures were in patients in whom signs of hydrocephalus first occurred after 1 month of age [p = 0.02]). Conclusions Endoscopic third ventriculostomy was successful in 71.4% of procedures in children younger than 2 years and in 75.0% of procedures in infants. Success of ETV in children younger than 2 years depends not on the age of the patient or cause of hydrocephalus but on the thickness of the floor of the third ventricle and the patient's age at first manifestation of hydrocephalus.

scholarly journals Effectiveness of Endoscopic Third Ventriculostomy in Obstructive Hydrocephalus of Different Etiology in Terms of Reduction of Ventricle Diameter

1969 ◽  
Vol 11 (4) ◽  
pp. 185-190
Author(s):  
Hamayun Tahir ◽  
Muhammad Ayaz ◽  
Mumtaz Ali ◽  
Naseer Hassan ◽  
Syed Nasir Shah ◽  
...  
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Case Series ◽  
Ventricular Volume ◽  
Third Ventriculostomy ◽  
Endoscopic Techniques ◽  
Case Series Study ◽  
3Rd Ventricle ◽  
The Difference

Background: Endoscopic techniques are now gaining insight into the management of various neurosurgical pathologies,including Endoscopic third ventriculostomy (ETV), which is a well-accepted technique for obstructive hydrocephalus of variousetiologies.Objective: To determine the effectiveness of endoscopic third ventriculostomy in obstructive hydrocephalus in terms of reductionof third ventricle diameter (width).Material and Method: This descriptive case series study was conducted at the Department of Neuro Surgery, Lady ReadingHospital, from January 2019 to December 2020. A total of 195 patients between age 1- 60 years meeting the inclusion criteriaunderwent endoscopic third ventriculostomy by a single expert neurosurgeon. Effectiveness of endoscopic third ventriculostomywas measured to reduce at least 1 mm or more from the baseline third ventricle diameter (width) after two months of surgery.Results: In our study, 127 (65.12%) patients were male, while 68 (34.87%) were Females. Mean, and S.D. forAge was as 30.05Years + 17.46.The Mean Baseline 3rd Ventricle Diameter was 5.218mm +1.1, whereas on 60th postoperative Day Follow Up, themean 3rd Ventricle Diameter was recorded as 4 .35mm +1.25. The difference in means between the two groups was 0.864 (pvalue<0.0001), which is statistically significant. Effectiveness of Endoscopic Third Ventriculostomy was recorded on 105 (53.84%)patients, whereas in 90 (46.15%) patients, Obstructive Hydrocephalus remained unchanged.Conclusion: Calculated volumetric measurements (e.g., width) from C.T. scans after successful third ventriculostomy can displaya demonstrable reduction in ventricular volume and help evaluate patients postoperatively.Keywords: ETV, Hydrocephalus, stereotactic.

scholarly journals A bi-foraminal craniometric-guided approach to endoscopic third ventriculostomy and biopsy of a pineal tumour

2021 ◽  
Vol 12 ◽  
pp. 582
Author(s):  
Panduranga Seetahal-Maraj ◽  
Patrick Knight ◽  
Narindra Ramnarine
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Third Ventriculostomy ◽  
Tumor Biopsy ◽  
Foramen Of Monro ◽  
Pineal Tumour ◽  
Pineal Tumors ◽  
Endoscopic Techniques ◽  
Intracranial Lesions

Background: Pineal tumors are very rarely encountered, with an incidence of <1% of intracranial lesions in adults. Life-threatening hydrocephalus due to obstruction of the third ventricle can result from the location of these tumours. Endoscopic third ventriculostomy (ETV) and tumor biopsy is a safe and feasible strategy, particularly if the tumor appears benign. This mitigates the high risks of uncontrollable venous bleeding from open and stereotactic biopsies. While typically performed using either ipsilateral single or dual bur holes, the location of the tumor may require modifications to the standard endoscopic techniques. Case Description: A 55-year-old male presented with signs of intracranial hypertension and was found to have obstructive hydrocephalus due to a pineal tumour. The tumour displayed a right-sided dominance when the pre-operative imaging was assessed, which would risk forniceal injury if biopsied via a right-sided burr hole. Craniometric measurements revealed a superior trajectory to the tumour via the left foramen of Monro. A biforaminal approach was performed, with a traditional ETV using a right coronal bur hole and biopsy via a left frontal bur hole. This minimized forniceal stretching and allowed a safe biopsy. Conclusion: The bi-foraminal approach has not been widely described in the literature but can potentially avoid morbidity with biopsy in patients with right-sided pineal tumours. We believe this technique should be considered, particularly in low-resource settings where neuroendoscopy is not commonly done, and where the use of ipsilateral single or dual-bur holes may lead to forniceal injury.

Preoperative third ventricular bowing as a predictor of endoscopic third ventriculostomy success

2012 ◽  
Vol 9 (2) ◽  
pp. 182-190 ◽  
Author(s):  
Brian J. Dlouhy ◽  
Ana W. Capuano ◽  
Karthik Madhavan ◽  
James C. Torner ◽  
Jeremy D. W. Greenlee
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Third Ventriculostomy ◽  
Lamina Terminalis ◽  
Time To Failure ◽  
Success Rates ◽  
Patient Age ◽  
The Third ◽  
Predominant Component ◽  
Patient Âgé ◽  
History Of

Object Patients with hydrocephalus often present with both intraventricular obstructive and communicating components, and determination of the predominant component is difficult. Other investigators have observed that third ventricular floor deformation, or “bowing” of the third ventricular floor, is a good indicator of intraventricular obstructive hydrocephalus, resulting in higher success rates with endoscopic third ventriculostomy (ETV). However, additional third ventricular bowing assessment and statistical evidence demonstrating a difference in ETV outcome with third ventricular bowing is needed. The authors hypothesized that patients with preoperative bowing of the third ventricle would exhibit greater long-term success rates after ETV and that lack of bowing would result in increased failure rates after ETV. Methods The authors determined success and failure for 59 ETVs performed in 56 patients, and recorded patient age, time to failure, and preoperative third ventricular anatomy, as well as history of infection, intraventricular hemorrhage, and previous shunt. Third ventricular anatomy was assessed on MR imaging for bowing, which was classified as any of the following: depression of the third ventricular floor, enlargement of the supraoptic recess, anterior curvature of the lamina terminalis, dilation of the proximal aqueduct to a greater extent than the distal aqueduct, and blunting or posterior bowing of the suprapineal recess. Univariate and multivariate analyses of ETV failure and the time to failure were performed using logistic regression and the Cox proportional hazards model, respectively. Results After adjusting for patient age and history of infection, there was a significant association between lack of anterior third ventricular preoperative bowing (either lamina terminalis, supraoptic recess, or third ventricular floor) and ETV failure (adjusted HR 2.79, 95% CI 1.08–7.20). Of the patients with bowing, 70.5% experienced success with ETV, as did 33.3% of the patients without bowing. Among the individual structures, absence of bowing in the anterior aspect of the third ventricular floor was significantly associated with censored time to ETV failure (multivariate HR 2.59, 95% CI 1.01–6.66; final model including age and history of infection). Conclusions The presence of preoperative third ventricular bowing is predictive of ETV success, with nearly a 3-fold likelihood of success compared with patients treated with ETV in the absence of such bowing. Although bowing is predictive, 33% of patients without bowing were also treated successfully with ETV.

Fourth Ventricle Outlet Obstruction and Diverticular Enlargement of Luschka Foramina in a Child with Down Syndrome

2020 ◽  
pp. 1-4
Author(s):  
Valentina Orlando ◽  
Pietro Spennato ◽  
Maria De Liso ◽  
Vincenzo Trischitta ◽  
Alessia Imperato ◽  
...  
Keyword(s):  
Down Syndrome ◽  
Fourth Ventricle ◽  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
Radiological Finding ◽  
Outlet Obstruction ◽  
Third Ventriculostomy ◽  
Viable Option ◽  
Case Presentation

<b><i>Introduction:</i></b> Hydrocephalus is not usually part of Down syndrome (DS). Fourth ventricle outlet obstruction is a rare cause of obstructive hydrocephalus, difficult to diagnose, because tetraventricular dilatation may suggest a communicant/nonobstructive hydrocephalus. <b><i>Case Presentation:</i></b> We describe the case of a 6-year-old boy with obstructive tetraventricular hydrocephalus, caused by Luschka and Magen­die foramina obstruction and diverticular enlargement of Luschka foramina (the so-called fourth ventricle outlet obstruction) associated with DS. He was treated with endoscopic third ventriculostomy (ETV) without complications, and a follow-up MRI revealed reduction of the ventricles, disappearance of the diverticula, and patency of the ventriculostomy. <b><i>Conclusion:</i></b> Diverticular enlargement of Luschka foramina is an important radiological finding for obstructive tetraventricular hydrocephalus. ETV is a viable option in tetraventricular obstructive hydrocephalus in DS.

scholarly journals GCT-53. CASE OF INTRACRANIAL GROWING TERATOMA SYNDROME WITH DIFFICULTY IN TIMING OF RESECTION

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii339-iii339
Author(s):  
Hidenobu Yoshitake ◽  
Hideo Nakamura ◽  
Yuta Hamamoto ◽  
Yusuke Otsu ◽  
Jin Kikuchi ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
Mature Teratoma ◽  
Timing Of Surgery ◽  
Optimal Timing ◽  
Third Ventriculostomy ◽  
Mixed Tumor ◽  
Gland Tumor ◽  
Growing Teratoma Syndrome

Abstract BACKGROUND Intracranial Growing teratoma syndrome(iGTS) is a phenomenon in which a tumor with a teratoma component grows during treatment, and its pathological tissue is often a mature teratoma. Here we report a case of iGTS in which the timing of surgery was determined by tumor markers and changes in tumor size on MRI images. CASE-REPORT: 11-year-old boy with a short stature. He developed a headache and we found a pineal gland tumor on MRI. Due to obstructive hydrocephalus, an endoscopic third ventriculostomy and biopsy were performed. The pathological diagnosis was mature teratoma, but AFP was elevated at 104.2 ng/mL. Considering NGGCT, we started chemoradiation immediately. Despite the declining AFP, it gradually increased, at which point we suspected iGTS. Resection was considered, but at some point tumor growth had stopped, so radiation therapy and a second course of ICE therapy preceded the resection. Thereafter, the tumor was completely removed, and a third course of ICE therapy was performed. DISCUSSION The onset mechanism of iGTS has not been elucidated, and its prediction is difficult. Early resection of the tumor is required, but discontinuation of radiation therapy and side effects of chemotherapy also need to be considered. In our case, resection was performed after normalization of AFP and recovery of myelosuppression. The patient followed an uneventful course, but the timing of resection was controversial. CONCLUSION We experienced a case of iGTS in NGGCT, a mixed tumor with mature teratoma. The optimal timing of the resection was discussed and literature was reviewed.

Endoscopic third ventriculostomy for obstructive hydrocephalus in children younger than 6 months of age: is it a first-choice method?

2008 ◽  
Vol 24 (9) ◽  
pp. 1021-1027 ◽  
Author(s):  
Radim Lipina ◽  
Štefan Reguli ◽  
Viera Doležilová ◽  
Marie Kunčíková ◽  
Hana Podešvová
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
Third Ventriculostomy ◽  
First Choice ◽  
Choice Method
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