Endoscopic third ventriculostomy in obstructive hydrocephalus: A case report and analysis of operative technique

BACKGROUND The endoscopic third ventriculostomy(ETV)is a neuroendoscopical procedure that represents a more suitable alternative to the extracranial shunting.It consists of fenestrating the floor of the third ventricle and thus establishing a free flow of the cerebrospinal fluid from the ventricles to the site of resorption in the subarachnoid space.It offers a more physiological solution and a chance at a shunt-free life for children with hydrocephalus.The main indication for the procedure is obstructive hydrocephalus,however,it can also be useful in patients with other forms of hydrocephalus.CASE SUMMARY We present a treatment flow of a 9-year-old patient,diagnosed with an obstructive hydrocephalus due to tectal glioma that was successfully treated with an ETV.We review the important factors influencing the success rate such as age,aetiology,shunt history,preoperative planning and visualisation of the basilar artery.CONCLUSION Even though the ETV effectively controls obstructive hydrocephalus in more than 75%of all cases,the overall success rate of the procedure varies and could be approved by the correct preoperative patient selection.

The Outcome of Endoscopic Third Ventriculostomy in a Mixed Population of Adult and Pediatric Patients

Background: Endoscopic third ventriculocisternostomy (ETV) is the most common neuroendoscopic technique in the treatment of noncommunicating hydrocephalus. Since its introduction, ETV has been a safe alternative to ventriculoperitoneal shunt (VP shunt), which has a high complication rate with significant socio-economic consequences. The authors report the results of ETV performed in the neurosurgical department of FANN teaching hospital in Dakar. Methods: This retrospective study presents the results of ETV performed in 513 patients with hydrocephalus of various etiologies, ranging from February 2010 to February 2018. We have included in our series from 2010 to 2016, all patients with clinically revealed non-communicating hydrocephalus followed by a brain computed tomography (CT) scan or brain magnetic resonance imaging (MRI) and who have benefited from an ETV, in which the ETV Success Score was evaluated. Results: The mean age of our patients was 14.10 years, with 298 (58%) males. The clinical symptomatology varied in both children and adults and manifested in children as macrocrania in 67.8% of the patients, while in adults, it manifested as raised intracranial pressure (ICP) in 87.5% of patients. A brain CT scan was performed in 461 (89.86%) of patients. The causes of hydrocephalus were dominated in 49% of patients by malformative pathologies, followed by tumors in 41% of patients, infections in 2.33% of patients, and normal-pressure hydrocephalus in 3.8% of patients. During the postoperative period, we found 21.41% of various complications. Conclusions: The findings in our series were compared to those in the literature and were satisfactory, thus proving the effectiveness and safety of ventriculocisternostomy in our department. In resource-limited countries, ETV can be performed with good results and less mortality and morbidity.

Endoscopic Third Ventriculostomy with or without Choroid Plexus Coagulation for Treatment of Hydrocephalus in Guinea: Analysis of 76 Cases in the Department of Neurosurgery of Kipe, Conakry

In low-income countries, endoscopic third ventriculostomy (ETV) with or without choroid plexus coagulation (CPC) is an increasingly accepted alternative to shunt therapy in adult and pediatric hydrocephalus. The authors report the result of this treatment in Conakry in a mixed population of adult and pediatric patients regardless of the etiology of the hydrocephalus. A retrospective study was conducted on 76 patients undergoing 89 ETV from January 2013 to September 2020. The predominant group of patients was infants less than one year with a mean age of 4.3 months and extremes of 1 - 8 months. The H/F sex ratio was 1.7/1. All patients presented acutely with signs of high intracranial pressure. Post-infectious causes and malformations and tumors were the main etiologies, respectively 21%, 47.3%, and 15.7%. The mean duration of the endoscopic procedures was 49.93 ± 10.9 mm, associated with a choroid plexus coagulation in 42% of cases. The complication rate in the first month was 22%, with CSF leak (5%) and death (11%) accounting for the majority. At three months, the complications rates were 45%, with 14.4% closed stroma, 6% epilepsy, and 24% mortality. The mean follow-up was 28 months (range 2 - 53), and the global success rate of 61%. Our study, with its limitations, shows that ETV with CPC is a safe primary approach for the treatment of hydrocephalus in low-income countries regardless of the etiology and the age of the patients.

Endoscopic third ventriculostomy in children:problems and surgical outcome:analysis of 34 cases

Background:Endoscopic third ventriculostomy(ETV)has been established as a viable treatment option for obstructive hydrocephalus of children over 6 weeks of age.ETV in pediatric groups may be unsuccessful due to the failure of absorption of cerebrospinal fluid(CSF)or reclosure of ventriculostomy stoma or due to infection.The exact cause is still debatable.Some issues like failure to eliminate the second membrane during the procedure or formation of the new arachnoid membrane at the stoma are still not clear.This study aims to assess the surgical failure of ETV and its predisposing factors.Methods:Thirty-four pediatric patients with hydrocephalus were analyzed retrospectively.The patients’age limit was between 2.5 months and 14 years.This is a retrospective study of 34 patients in a single private hospital between June 2012 and January 2018.Patients having hydrocephalus in pediatric groups more than 6 weeks of age were included in the study.Results:The mean age of all patients was 51.25±53.90 months and the mean follow-up period was 50.47±20.84 months.Of 34 surgeries,the success rate was 79%and the failure rate was 21%.Within 2 years,the success rate was 68.42%and above 2 years’success rate was 93.33%.In this series,7 cases of ETV were re-explored and found ventriculostomy stoma closure in 3 cases,the presence of the second membrane in re-exploration 2 cases,and presence of inflammatory arachnoid membrane in re-exploration 2 cases.The use of dexamethasone around the stoma in inflammatory stoma was useful,having no recurrence.In one patient of the second membrane probably due to absorption failure in communicating hydrocephalus re-exploration was failed and was managed successfully with VP shunt.Conclusions:Predisposing factors causing ETV failure are ventriculostomy stoma closure by new arachnoid granulation tissues,remnants of the second membrane inside the stoma,CSF absorption failure,infection/high protein in CSF and inappropriate patient selection.

Simultaneous biportal endoscopic management of pineal region tumors in patients with obstructive hydrocephalus:technical notes

Background The goal of this study is to show the feasibility and benefits of using the simultaneous biportal endoscopic procedure to treat pineal tumors in patients with obstructive hydrocephalus.Methods We retrospectively reviewed three patients with pineal tumors and acute obstructive hydrocephalus who were treated in one session with a frameless stereotactic guided simultaneous biportal endoscopic third ventriculostomy and endoscopic tumor biopsy performed through two separate ports using one rigid ventriculoscope.Results In the three patients,ventriculostomy and endoscopic biopsies were conducted.There was no death or morbidity throughout the 45-min procedure.All of the patients’histological findings were confirmed.Germinoma was diagnosed in two patients who recieved postoperative radiotherapy,and the third patient diagnosed with a pineocytoma.Magnetic resonance imaging with flow-sensitive sequences was used to confirm ventriculostomy patency in all patients 6 months after the surgery.Conclusion Biportal endoscopic approach enables better visual control of both procedures.Furthermore,it allows the surgeon to safely pass the ventriculoscope via the foramen of monro,even if it is narrow.Moreover,during endoscopic tumor biopsy and third ventriculostomy,the intracranial pressure can be smoothly managed using the outlet tubes accessible.This treatment may be an alternative to traditional uniportal endoscopic operations in certain patients.

Simultaneous biportal endoscopic management of pineal region tumors in patients with obstructive hydrocephalus:technical notes

Background The goal of this study is to show the feasibility and benefits of using the simultaneous biportal endoscopic procedure to treat pineal tumors in patients with obstructive hydrocephalus.Methods We retrospectively reviewed three patients with pineal tumors and acute obstructive hydrocephalus who were treated in one session with a frameless stereotactic guided simultaneous biportal endoscopic third ventriculostomy and endoscopic tumor biopsy performed through two separate ports using one rigid ventriculoscope.Results In the three patients,ventriculostomy and endoscopic biopsies were conducted.There was no death or morbidity throughout the 45-min procedure.All of the patients’histological findings were confirmed.Germinoma was diagnosed in two patients who recieved postoperative radiotherapy,and the third patient diagnosed with a pineocytoma.Magnetic resonance imaging with flow-sensitive sequences was used to confirm ventriculostomy patency in all patients 6 months after the surgery.Conclusion Biportal endoscopic approach enables better visual control of both procedures.Furthermore,it allows the surgeon to safely pass the ventriculoscope via the foramen of monro,even if it is narrow.Moreover,during endoscopic tumor biopsy and third ventriculostomy,the intracranial pressure can be smoothly managed using the outlet tubes accessible.This treatment may be an alternative to traditional uniportal endoscopic operations in certain patients.