Endoscopic Third Ventriculostomy for Hydrocephalus Secondary to Extraventricular Obstruction in Thalamic Hemorrhage: A Case Series

2020 ◽  
Vol 19 (4) ◽  
pp. 384-392
Author(s):  
Hussein A Zeineddine ◽  
Antonio Dono ◽  
Ryan Kitagawa ◽  
Sean I Savitz ◽  
Huimahn Alex Choi ◽  
...  
Keyword(s):  
Intracranial Hemorrhage ◽  
Endoscopic Third Ventriculostomy ◽  
Case Series ◽  
External Ventricular Drainage ◽  
Tube Placement ◽  
Third Ventriculostomy ◽  
Shunt Placement ◽  
Cerebrospinal Fluid Diversion ◽  
Thalamic Hemorrhage ◽  
Gastrostomy Tube Placement

Abstract BACKGROUND Intracranial hemorrhage carries significant morbidity and mortality, particularly if associated with hydrocephalus. Management of hydrocephalus includes temporary external ventricular drainage, with or without shunting. Thalamic location is an independent predictor of mortality and increases the likelihood of shunt dependence. OBJECTIVE To determine whether endoscopic third ventriculostomy (ETV) can avoid the need for shunt placement and expedite recovery. METHODS We prospectively identified thalamic intracranial hemorrhage patients who developed acute hydrocephalus requiring cerebrospinal fluid diversion by extraventricular drain placement from November 2017 to February 2019. Patients who failed an extraventricular drain clamping trial were then evaluated for eligibility for an ETV procedure. Patients who underwent ETV were then followed up for the development of hydrocephalus, need for shunting, and length of stay in the intensive care unit. RESULTS Eight patients (7 males, 1 female) were prospectively enrolled. All patients underwent an ETV successfully. None of the patients required shunting. ETV was performed despite the presence of other factors that would have prevented shunt placement, including fever, leukocytosis, and gastrostomy tube placement. Seven patients who underwent ETV were evaluated at 3-mo follow-up and did not require shunting. CONCLUSION ETV is a safe and effective technique for the management of hydrocephalus resulting from an extraventricular obstruction in thalamic hemorrhage. It can avoid the need for permanent shunting in this patient population. Larger studies should be conducted to validate and further analyze this intervention.

Endoscopic Third Ventriculostomy for Hydrocephalus Secondary to Extraventricular Obstruction in Thalamic Hemorrhage: A Case Series

Neurosurgery ◽  
2021 ◽  
Vol 89 (Supplement_2) ◽  
pp. S148-S148
Author(s):  
Hussein A Zeineddine ◽  
Antonio Dono ◽  
Ryan Kitagawa ◽  
Sean I Savitz ◽  
Huimahn Alex Choi ◽  
...  
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Case Series ◽  
Third Ventriculostomy ◽  
Thalamic Hemorrhage

scholarly journals OBSTRUCTIVE HYDROCEPHALUS;

2019 ◽  
Vol 26 (02) ◽  
Author(s):  
NAUMAN Shakeel ◽  
Aaamir Aziz ◽  
Muhammad Faaiq Farooq ◽  
Faheem Usmani ◽  
Tariq Salahuddin
Keyword(s):  
Intracranial Hemorrhage ◽  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Case Series ◽  
Signs And Symptoms ◽  
Third Ventriculostomy ◽  
Traditional Treatment ◽  
Operative Evaluation ◽  
A Prospective Study

Introduction: Management of Hydrocephalus has always amazed and challenged clinicians throughout the history of medicine. The traditional treatment for all forms of hydrocephalus has been the implantation of Ventriculoperitoneal Shunt (VPS) system. Because of deployment of implant, this procedure inherently associated with certain common complications, infection approximately 24.6% of all shunt operations. Moreover, the risk of postoperative seizures is 25% and intracranial hemorrhage is 3.5%. Endoscopic Third Ventriculostomy (ETV) is a surgical procedure that allows the Cerebrospinal Fluid (CSF) to flow directly from the third ventricle to the basal cisterns and subarachnoid spaces, ETV has been established as a safe treatment for obstructive hydrocephalus because in this procedure there is no implant is deployed, that’s why rate of post operative complications is low as compare to VPS as intracranial infection found in 8% patient, intracranial hemorrhage in 5%and 1% patient developed seizure post ETV. Objectives: Objective of this study is to determine the frequency of short term complications of endoscopic third ventriculostomy in obstructive hydrocephalus. Study Design: Descriptive case series. Setting: Department of Neurosurgery, Lahore General Hospital, Lahore. Duration with Dates: Six months: from 01-07-2011 to 31-12-2011. Methods: This was a prospective study of in which 45 patients underwent Endoscopic third ventriculostomy for Obstructive hydrocephalus. The outcome of interest was to assess the frequency of complications like infection, hemorrhage and seizures following the ETV in patient with obstructive hydrocephalus. Data was collected on a specially designed Performa. Demographic details, signs and symptoms at presentation, details of post operative evaluation (mortality and neurological deficiency) were noted. Results: A total of 45 patients underwent in ETV for the treatment of obstructive hydrocephalus. Complications were observed in eight (17.8%) cases in which five patients had only one complication and three patients had multiple (two) complications. Regarding type of complication, Infection was observed in six (13.3%) cases, hemorrhage was observed in four (8.9%) cases and wound CSF leakages was seen in only one (2.2%) case. Conclusion: Endoscopic third ventriculostomy is recent advances in the management of obstructive hydrocephalus, it has lesser complications (Infection, Hemorrhage, seizures) and long term failure rate is low as compare to the traditional treatment of obstructive hydrocephalus.

Transventricular, transaqueductal scope-in-scope endoscopic excision of fourth ventricular neurocysticercosis: a series of 13 cases and a review

2008 ◽  
Vol 1 (1) ◽  
pp. 35-39 ◽  
Author(s):  
Ashish Suri ◽  
Rohit Kumar Goel ◽  
Faiz Uddin Ahmad ◽  
Ananth Kesav Vellimana ◽  
Bhawani Shankar Sharma ◽  
...  
Keyword(s):  
English Language ◽  
Third Ventriculostomy ◽  
Cyst Excision ◽  
Shunt Placement ◽  
Cerebrospinal Fluid Diversion ◽  
The Central Nervous System ◽  
The Mean ◽  
Clinical Records ◽  
Ventricle Size

Object Neurocysticercosis (NCC) is the most common parasitic infestation of the central nervous system worldwide. In patients presenting with acute hydrocephalus due to intraventricular NCC, surgery is the only option. Still, there is no consensus regarding the optimal surgical strategy, although neuroendoscopic excision is a promising method. However, the literature regarding the use of this modality in fourth ventricular NCC is scarce. The authors describe a series of patients with fourth ventricular NCC treated endoscopically. Methods The clinical records of 13 patients with fourth ventricular NCC who had presented with hydrocephalus were retrospectively analyzed. A fourth ventricular cyst was completely excised in all patients by using a transventricular, transaqueductal “scope-in-scope” endoscopic technique. Twelve endoscopic third ventriculostomies and 1 septostomy had been performed. Results Shunt placement was avoided in all patients. There were minimal peri- and postoperative complications. The mean duration of follow-up was 22.3 months (range 3–41 months). All patients had an improved clinical outcome. Follow-up neuroimaging revealed no residual lesion and a decreased ventricle size in all patients. Conclusions The present series of patients with fourth ventricular NCC is the largest in the existing English-language medical literature. Endoscopic fourth ventricular cysticercal cyst excision along with internal cerebrospinal fluid diversion via endoscopic third ventriculostomy is an effective alternative to open microneurosurgical procedures and avoids shunt placement and its related complications.

Brain Tectal Tumors: A Flexible Approach

2018 ◽  
Vol 16 (3) ◽  
pp. E95-E100
Author(s):  
Alessandro Perin ◽  
Tommaso Francesco Galbiati ◽  
Cecilia Casali ◽  
Federico Giuseppe Legnani ◽  
Luca Mattei ◽  
...  
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Good Prognosis ◽  
Endoscopic Biopsy ◽  
Third Ventriculostomy ◽  
Histopathological Diagnosis ◽  
Cerebrospinal Fluid Diversion ◽  
Oncological Patients ◽  
Slow Progression ◽  
Benign Histology ◽  
Midbrain Tumors

Abstract BACKGROUND AND IMPORTANCE Mesencephalic tectal gliomas represent a subset of midbrain tumors, which are more frequent in children than in adults. They usually become symptomatic when causing hydrocephalus by occluding the aqueduct. Because of their slow progression, due to their benign histology, they are characterized by a relatively good prognosis, although hydrocephalus might jeopardize patients’ prognosis. Treatment is usually represented by cerebrospinal fluid diversion associated or not with biopsy. CLINICAL PRESENTATION We report 2 illustrative cases of tectal gliomas in adults where endoscopic third ventriculostomy (ETV) and simultaneous endoscopic biopsy were obtained during the same operation by means of a single burr hole with a flexible endoscope. CONCLUSION We recommend using this overlooked neurosurgical tool for such cases, since it allows the surgeon to safely perform an ETV, then judge whether biopsy can be done or not, without harming the patient, and possibly achieving an important piece of information (histopathological diagnosis) to manage this subset of oncological patients.

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.

Endoscopic Third Ventriculostomy for Occlusive Hydrocephalus Caused by Cerebellar Infarction

Neurosurgery ◽  
2006 ◽  
Vol 59 (3) ◽  
pp. 539-544 ◽  
Author(s):  
Jörg Baldauf ◽  
Joachim Oertel ◽  
Michael R. Gaab ◽  
Henry W.S. Schroeder
Keyword(s):  
Glasgow Coma Scale ◽  
Scale Score ◽  
Glasgow Coma Scale Score ◽  
Glasgow Outcome Scale ◽  
Endoscopic Third Ventriculostomy ◽  
External Ventricular Drainage ◽  
Third Ventriculostomy ◽  
Cerebellar Infarction ◽  
Ventricular Drainage ◽  
Occlusive Hydrocephalus

Abstract OBJECTIVE: The surgical management of occlusive hydrocephalus caused by massive cerebellar infarction remains controversial. The procedures that are more commonly used to avoid progressive neurological deterioration are based on transient external ventricular drainage or the placement of permanent shunt systems. To our knowledge, this is the first report regarding using endoscopic third ventriculostomy (ETV) in patients with an occlusive hydrocephalus caused by cerebellar ischemic stroke. We report our experience of 10 reviewed cases. METHODS: Between 1997 and 2004, 10 patients with a resulting hydrocephalus caused by a space-occupying cerebellar infarction were managed with ETV. Glasgow Coma Scale score on admission, cause of stroke, and computed tomographic signs, including the ischemic vascular territory involved and brain edema, were noted. Clinical outcome was evaluated using the Glasgow Outcome Scale. RESULTS: In all patients, there was a mean interval of 4 days from the onset of deterioration of consciousness to operation. Mean Glasgow Coma Scale score on admission was 11.2. In nine patients, ETV was the initial procedure of ventricular drainage. One patient was primarily treated with an external ventricular drainage, but the device dislocated and ETV was performed. In one patient, an external ventricular drainage became necessary 7 days after the initial ETV because of a malfunction of the stoma. One patient showed a progressive brain edema 2 days after ETV, and suboccipital decompression was performed. Eight successfully treated patients demonstrated an improvement in the level of consciousness after ETV. Mean Glasgow Outcome Scale score on discharge of all patients was 3.4. CONCLUSION: Occlusive hydrocephalus caused by cerebellar infarction is infrequent. When occlusive hydrocephalus is observed, ETV can be used successfully with minimal risks, especially with avoidance of a higher rate of infectious complications caused by external drainage systems.

Involution of enhancing intrinsic tectal tumors after endoscopic third ventriculostomy

1999 ◽  
Vol 91 (5) ◽  
pp. 863-866 ◽  
Author(s):  
Ahmed M. Alkhani ◽  
Frederick A. Boop ◽  
James T. Rutka
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Treatment Plan ◽  
Obstructive Hydrocephalus ◽  
Neurofibromatosis Type ◽  
Third Ventriculostomy ◽  
Unexpected Result ◽  
Imaging Studies ◽  
Content Type ◽  
Cerebrospinal Fluid Diversion

✓ For benign intrinsic tectal tumors causing triventricular obstructive hydrocephalus, cerebrospinal fluid diversion followed by neuroimaging is a widely accepted treatment plan. In this report, the authors describe two children with focal enhancing tectal lesions that caused acute, symptomatic hydrocephalus. One child had neurofibromatosis Type 1 (NF1). In both children the hydrocephalus was effectively treated by endoscopic third ventriculostomy. Following this procedure, serial imaging studies revealed not only that the ventriculomegaly had resolved, but also that the enhancing tectal tumors had regressed and disappeared over time. The time to complete involution of these tumors was 18 months for the child with NF1 and 12 months for the other child. To the authors' knowledge, this is the first report of the involution of enhancing tectal tumors after endoscopic third ventriculostomy. The possible mechanisms for this unexpected result are discussed.

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

2003 ◽  
Vol 98 (5) ◽  
pp. 1032-1039 ◽  
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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