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Verma R. "Various factors affecting the success of the ETV procedure in infants"-an insight via a prospective study. Childs Nerv Syst 2024; 40:1515-1523. [PMID: 38157047 DOI: 10.1007/s00381-023-06268-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 12/22/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Congenital hydrocephalus in infants treated with ETV has variable results in literature. We studied some supposed clinicoradiological parameters which though are considered vital in deciding operative management and have never been thoroughly studied to establish a well-defined association. AIM AND OBJECTIVE To evaluate the influence of clinicoradiological profile and intraoperative findings over the outcome of ETV done in infants for congenital hydrocephalus. MATERIALS AND METHODS All infants who underwent ETV in King George's Medical University, Lucknow, from January 2019 to February 2020 for congenital hydrocephalus were included. Their clinical, radiological, operative data was gathered. Infants were followed at 1, 3, and 6 months after ETV. ETV success was defined as stabilization of abnormal head growth with resolution of symptoms of raised ICP and no requirement of shunt surgery 6 months post-ETV. All the clinicoradiological and intraoperative factors were statistically correlated with the final outcome. RESULTS Forty infants were operated for congenital hydrocephalus during the study period in our institution. Failure rate was higher in children younger than 3 months (p value of 0.04). Increase in head size was present in all 40 cases and bulging anterior fontanelle in 95% cases. Success rate of ETV at 1, 3, and 6 months was 62.5%, 40%, and 35%. Most of failure occurred within 3 months after the procedure. Expiry rate at 1, 3, and 6 month was 15%, 17.5%, and 17.5%. None of the intraoperative findings significantly correlated with the final outcome. CONCLUSION ETV can be a luring treatment of congenital hydrocephalus in infants but has limited success rate because of the dependency of procedure on well-formed arachnoid villi for absorption. It also carries minimal risk of fatal complications like CSF leak and meningitis associated with it. Age is the only factor which truly reflects the outcome of the procedure.
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Affiliation(s)
- Rajat Verma
- Department of Neurosurgery, Kings George Medical University, Uttar Pradesh, Lucknow, India.
- , U.P, Lucknow, 226002, India.
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Milan JB, Jensen TSR, Nørager N, Pedersen SSH, Riedel CS, Toft NM, Ammar A, Foroughi M, Grotenhuis A, Perera A, Rekate H, Juhler M. The ASPECT Hydrocephalus System: a non-hierarchical descriptive system for clinical use. Acta Neurochir (Wien) 2023; 165:355-365. [PMID: 36427098 PMCID: PMC9922243 DOI: 10.1007/s00701-022-05412-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 10/27/2022] [Indexed: 11/26/2022]
Abstract
In patients with hydrocephalus, prognosis and intervention are based on multiple factors. This includes, but is not limited to, time of onset, patient age, treatment history, and obstruction of cerebrospinal fluid flow. Consequently, several distinct hydrocephalus classification systems exist. The International Classification of Diseases (ICD) is universally applied, but in ICD-10 and the upcoming ICD-11, hydrocephalus diagnoses incorporate only a few factors, and the hydrocephalus diagnoses of the ICD systems are based on different clinical measures. As a consequence, multiple diagnoses can be applied to individual cases. Therefore, similar patients may be described with different diagnoses, while clinically different patients may be diagnosed identically. This causes unnecessary dispersion in hydrocephalus diagnostics, rendering the ICD classification of little use for research and clinical decision-making. This paper critically reviews the ICD systems for scientific and functional limitations in the classification of hydrocephalus and presents a new descriptive system. We propose describing hydrocephalus by a system consisting of six clinical key factors of hydrocephalus: A (anatomy); S (symptomatology); P (previous interventions); E (etiology); C (complications); T (time-onset and current age). The "ASPECT Hydrocephalus System" is a systematic, nuanced, and applicable description of patients with hydrocephalus, with a potential to resolve the major issues of previous classifications, thus providing new opportunities for standardized treatment and research.
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Affiliation(s)
| | - Thorbjørn Søren Rønn Jensen
- Copenhagen CSF Study Group, Copenhagen, Denmark
- Department of Neurosurgery 6031, Rigshospitalet, Inge Lehmanns Vej 6, Copenhagen, DK 2100, Denmark
| | | | - Sarah Skovlunde Hornshøj Pedersen
- Copenhagen CSF Study Group, Copenhagen, Denmark
- Department of Neurosurgery 6031, Rigshospitalet, Inge Lehmanns Vej 6, Copenhagen, DK 2100, Denmark
| | - Casper Schwartz Riedel
- Copenhagen CSF Study Group, Copenhagen, Denmark
- Department of Neurosurgery 6031, Rigshospitalet, Inge Lehmanns Vej 6, Copenhagen, DK 2100, Denmark
| | | | - Ahmed Ammar
- Department of Neurosurgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
- European Association of Neurosurgical Societies (EANS) CSF Task Force, Brussels, Belgium
| | - Mansoor Foroughi
- European Association of Neurosurgical Societies (EANS) CSF Task Force, Brussels, Belgium
- Department of Neurosurgery, Wellington Hospital, London, UK
| | - André Grotenhuis
- European Association of Neurosurgical Societies (EANS) CSF Task Force, Brussels, Belgium
- Department of Neurosurgery, Radboud University Nijmegen Medical Centre, Nijmegen, Holland, Netherlands
| | - Andrea Perera
- Department of Basic and Clinical Neuroscience, Kings College London, Maurice Wohl Clinical Neuroscience Institute, London, UK
| | - Harold Rekate
- European Association of Neurosurgical Societies (EANS) CSF Task Force, Brussels, Belgium
- Department of Neurosurgery, Hofstra Northwell School of Medicine in Hempstead, Hempstead, NY, USA
| | - Marianne Juhler
- Copenhagen CSF Study Group, Copenhagen, Denmark.
- Department of Neurosurgery 6031, Rigshospitalet, Inge Lehmanns Vej 6, Copenhagen, DK 2100, Denmark.
- European Association of Neurosurgical Societies (EANS) CSF Task Force, Brussels, Belgium.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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Kumar S, Sahana D, Rathore L, Jain A, Tawari M, Singh D, Sahu R, Madhariya SN. Extra-axial endoscopic third ventriculostomy: preliminary experience with a technique to circumvent conventional endoscopic third ventriculostomy complications. J Neurosurg 2023; 138:503-513. [PMID: 35901703 DOI: 10.3171/2022.5.jns22589] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 05/16/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Endoscopic third ventriculostomy (ETV) is mostly safe but may have serious complications. Most of the complications are inherent to the procedure's intra-axial nature. This study aimed to explore an alternative route to overcome inherent issues with conventional ETV. The authors performed supraorbital, subfrontal extra-axial ETV (EAETV) via the lamina terminalis. METHODS This prospective study began in October 2021 and included patients with obstructive triventricular hydrocephalus with a Glasgow Coma Scale score of 8 or more and a minimum follow-up of 3 months. Patients with multiloculated hydrocephalus and those younger than 1 year of age were excluded. The preoperative parameters etiology, symptoms, Evans' Index, frontal occipital horn ratio (FOHR), and third ventricle index were recorded. The surgical procedure is described. Postoperative evaluation included clinical (modified Rankin Scale [mRS]) and radiological assessment with CT and cine phase-contrast MRI. Preoperative and postoperative parameters were compared statistically. RESULTS Ten patients were included in this study. Six patients had acute hydrocephalus, and 4 had chronic hydrocephalus. After EAETV, all patients showed clinical improvement. An mRS score of 0 or 1 was achieved in 9 patients, but the mRS score remained at 4 in a patient with tectal tuberculoma. There was a significant reduction in Evans' Index, FOHR, and third ventricle index after EAETV (p < 0.05). The mean percent reduction in Evans' Index was 20.80% ± 13.89%, the mean percent reduction in FOHR was 20.79% ± 12.98%, and the mean percent reduction in the third ventricle index was 37.45% ± 14.74%. CSF flow voids were seen in all cases. The results of CSF flow quantification parameters were as follows: mean peak velocity 3.82 ± 0.93 cm/sec, mean average velocity 0.10 ± 0.05 cm/sec, mean average flow rate 46.60 ± 28.58 μL/sec, mean forward volume 39.90 ± 23.29 μL, mean reverse volume 34.10 ± 15.98 μL, mean overall flow amplitude 74.00 ± 27.61 μL, and mean stroke volume 37.00 ± 13.80 μL. One patient developed a minor frontal lobe contusion. The frontal air sinus was breached in 5 patients, but none had CSF rhinorrhea. Transient supraorbital hypesthesia was seen in 3 patients. No patient had electrolyte disturbance or change in thirst or fluid intake habits. CONCLUSIONS EAETV is a feasible, safe, and effective surgical alternative to conventional ETV.
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Affiliation(s)
- Sanjeev Kumar
- 1Department of Neurosurgery, DKS Post Graduate Institute and Research Center, Raipur Chhattisgarh
| | - Debabrata Sahana
- 1Department of Neurosurgery, DKS Post Graduate Institute and Research Center, Raipur Chhattisgarh
| | - Lavlesh Rathore
- 1Department of Neurosurgery, DKS Post Graduate Institute and Research Center, Raipur Chhattisgarh
| | - Amit Jain
- 1Department of Neurosurgery, DKS Post Graduate Institute and Research Center, Raipur Chhattisgarh
| | - Manish Tawari
- 1Department of Neurosurgery, DKS Post Graduate Institute and Research Center, Raipur Chhattisgarh
| | - Deepak Singh
- 2Department of Neuro-anesthesia, DKS Post Graduate Institute and Research Center, Raipur Chhattisgarh; and
| | - Rajiv Sahu
- 1Department of Neurosurgery, DKS Post Graduate Institute and Research Center, Raipur Chhattisgarh
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Repeat endoscopic third ventriculostomy combined with choroid plexus cauterization as salvage surgery for failed endoscopic third ventriculostomy. Childs Nerv Syst 2022; 38:1313-1319. [PMID: 35438316 DOI: 10.1007/s00381-022-05488-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/03/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Although the endoscopic third ventriculostomy (ETV) is an effective treatment for hydrocephalus, failures do on occasion occur. In such cases, a repeat ETV or shunt insertion is usually performed. However, there is, as of yet, no clear consensus on the best measure to take in the event of a failed ETV. We herein examined the outcomes of a repeat ETV combined with choroid plexus cauterization for ETV failure. METHODS All patients who underwent an ETV at the Department of Neurosurgery at Tokyo Metropolitan Children's Medical Center between April 2013 and March 2019 were retrospectively analyzed. RESULTS In total, 36 patients received an ETV. Six patients experienced ETV failure; three of these underwent a repeat ETV combined with choroid plexus cauterization. Three of the six patients who experienced early ETV failure received a ventriculoperitoneal shunt. During the median follow-up period of 42 months (range: 32-73 months), all repeat ETVs were successful. CONCLUSION A repeat ETV combined with choroid plexus cauterization can be an effective salvage therapy in the event of ETV failure.
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Zhang C, Zhang T, Ge L, Li Z, Chen J. Management of Posterior Fossa Tumors in Adults Based on the Predictors of Postoperative Hydrocephalus. Front Surg 2022; 9:886438. [PMID: 35722528 PMCID: PMC9198439 DOI: 10.3389/fsurg.2022.886438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThis study aims to identify the predictors of postoperative hydrocephalus in patients with posterior fossa tumors (PFTs) and guide the management of perioperative hydrocephalus.MethodsWe performed a single-institution, retrospective analysis of patients who underwent resection of PFTs in our department over a 10-year period (2011–2021). A total of 682 adult patients met the inclusion criteria and were divided into either a prophylactic external ventricular drainage (EVD) group or a nonprophylactic-EVD group. We analyzed data for the nonprophylactic-EVD group by univariate and multivariate analyses to identify predictors of postoperative acute hydrocephalus. We also analyzed all cases by univariate and multivariate analyses to determine the predictors of postoperative ventriculoperitoneal (VP) shunt placement.ResultsTumor infiltrating the midbrain aqueduct [P = 0.001; odds ratio (OR) = 9.8], postoperative hemorrhage (P < 0.001; OR = 66.7), and subtotal resection (P = 0.006; OR = 9.3) were independent risk factors for postoperative EVD. Tumor infiltrating the ventricular system (P < 0.001; OR = 58.5) and postoperative hemorrhage (P < 0.001; OR = 28.1) were independent risk factors for postoperative VP shunt placement.ConclusionsThese findings may help promote more aggressive monitoring and earlier interventions for postoperative hydrocephalus in patients with PFTs.
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Affiliation(s)
- Chengda Zhang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Neurosurgery, Affiliated Hospital of Hubei University of Medicine, First People’s Hospital of Xiangyang, Xiangyang, China
| | - Tingbao Zhang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Lingli Ge
- Department of Paediatrics, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Central Hospital of Xiangyang, Xiangyang, China
| | - Zhengwei Li
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Correspondence: Jincao Chen Zhengwei Li
| | - Jincao Chen
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Correspondence: Jincao Chen Zhengwei Li
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Sharafat S, Khan Z, Azam F, Ali M. Frequency of success and complications of primary endoscopic third ventriculostomy in infants with obstructive hydrocephalous. Pak J Med Sci 2022; 38:267-270. [PMID: 35035437 PMCID: PMC8713220 DOI: 10.12669/pjms.38.1.4097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 08/27/2021] [Accepted: 09/12/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To determine the success rate and complications of primary endoscopic third ventri-culostomy (ETV) in infants with obstructive hydrocephalous. METHODS This case series was conducted at the Department of Neurosurgery, Medical and Teaching Institute, Lady Reading Hospital Peshawar from July 2016 to June 2018. All consecutive patients with age less than one year who underwent ETV for primary obstructive hydrocephalous, of both gender, were included in the study. The patients were followed up to six months after surgery. The data was entered in a specially designed Performa. Patients' data was analyzed using SPSS version 21.0. RESULTS We had total 21 patients with age less than one year during the study period. Male patients were 11 (52.4%). Success rate of ETV at six months of follow up was 12 (57.1%). Post-op complications observed were in 9.52% (2/21) cases. One patient had cerebrospinal fluid CSF) leak and the other had significant bleed. CONCLUSION ETV is successful in 57.1% of infants with obstructive type of hydrocephalous. The post op complications in case of ETV are lower than Ventriculo-peritoneal shunts. Therefore, ETV can be offered to infants having obstructive hydrocephalous.
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Affiliation(s)
- Seema Sharafat
- Seema Sharafat, FCPS. Department of Neurosurgery Medical and Teaching Institute, Lady Reading Hospital, Peshawar, Pakistan
| | - Zahid Khan
- Zahid Khan, FCPS. Department of Neurosurgery Medical and Teaching Institute, Lady Reading Hospital, Peshawar, Pakistan
| | - Farooq Azam
- Farooq Azam FCPS. Department of Neurosurgery Medical and Teaching Institute, Lady Reading Hospital, Peshawar, Pakistan
| | - Mumtaz Ali
- Mumtaz Ali, FCPS. Department of Neurosurgery Medical and Teaching Institute, Lady Reading Hospital, Peshawar, Pakistan
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Su GJ, Gao J, Wu CW, Zou JF, Zhu DL, Liu J, Zhang JH, Huang XJ. Long-standing overt ventriculomegaly in adulthood with primary presentation of psychiatric disturbance: A case report. Medicine (Baltimore) 2021; 100:e27794. [PMID: 34889231 PMCID: PMC8663855 DOI: 10.1097/md.0000000000027794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/29/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Hydrocephalus is a common disease in neurosurgery. The typical symptoms of hydrocephalus include urinary incontinence, gait instability, and cognitive decline. Irritability rarely occurs in patients with hydrocephalus. Irritability rarely occurs in patients with hydrocephalus, especially in long-standing overt ventriculomegaly of adulthood (LOVA). PATIENT CONCERNS A 30-year-old female was admitted to our hospital because of mental retardation and unstable gait for more than 15 years. She had undergone ventriculoperitoneal shunt 15 years prior due to ventriculomegaly and related symptoms. However, the shunt catheter was removed shortly after surgery because of blockage, with no further postoperative treatment. DIAGNOSIS The patient was diagnosed with long-standing overt ventriculomegaly according to her head circumference and clinical symptoms, including adult hydrocephalus development, overt triventriculomegaly and absence of a secondary cause for aqueductal stenosis in adulthood. INTERVENTIONS After considerable discussion, she underwent ventriculoperitoneal shunt placement and showed dramatic and sustained improvement. OUTCOMES The patient has been followed at 3-month intervals for over 2 years since discharge, and both the patient and family have reported a significant change in their daily life. She was able to live independently and control her emotions. Slight epilepsy was noted approximately 5 months after surgery but recovered 2 months later. LESSONS It is difficult to decide whether to treat LOVA when the in patients whose symptoms are not significant. We believe that early diagnosis and positive treatment can help improve outcomes and would recommend ventriculoperitoneal (VP) shunting in patients with LOVA.
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Gürbüz MS, Dağçınar A, Bayri Y, Şeker A, Güçlü H. Anterior third ventricular height and infundibulochiasmatic angle: two novel measurements to predict clinical success of endoscopic third ventriculostomy in the early postoperative period. J Neurosurg 2020; 132:1764-1772. [PMID: 31075772 DOI: 10.3171/2019.1.jns181330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 01/29/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The authors sought to develop a set of parameters that reliably predict the clinical success of endoscopic third ventriculostomy (ETV) when assessed before and after the operation, and to establish a plan for MRI follow-up after this procedure. METHODS This retrospective study involved 77 patients who had undergone 78 ETV procedures for obstructive hydrocephalus between 2010 and 2015. Constructive interference in steady-state (CISS) MRI evaluations before and after ETV were reviewed, and 4 parameters were measured. Two well-known standard parameters, fronto-occipital horn ratio (FOHR) and third ventricular index (TVI), and 2 newly defined parameters, infundibulochiasmatic (IC) angle and anterior third ventricular height (TVH), were measured in this study. Associations between preoperative measurements of and postoperative changes in the 4 variables and the clinical success of ETV were analyzed. RESULTS Of the 78 ETV procedures, 70 (89.7%) were successful and 8 (10.3%) failed. On the preoperative MR images, the mean IC angle and anterior TVH were significantly larger in the successful procedures. On the 24-hour postoperative MR images of the successful procedures, the mean IC angle declined significantly from 114.2° to 94.6° (p < 0.05) and the mean anterior TVH declined significantly from 15 to 11.2 mm (p < 0.05). The mean percentage reduction of the IC angle was 17.1%, and that of the anterior TVH was 25.5% (both p < 0.05). On the 1-month MR images of the successful procedures, the mean IC angle declined significantly from 94.6° to 84.2° (p < 0.05) and the mean anterior TVH declined significantly from 11.2 to 9.3 mm (p < 0.05). The mean percentage reductions in IC angle (11%) and anterior TVH (16.9%) remained significant at this time point but were smaller than those observed at 24 hours. The 6-month and 1-year postoperative MR images of the successful group showed no significant changes in mean IC angle or mean anterior TVH. Regarding the unsuccessful procedures, there were no significant changes observed in IC angle or anterior TVH at any of the time points studied. Reduction of IC angle and reduction of anterior TVH on 24-hour postoperative MR images were significantly associated with successful ETV. However, no clinically significant association was found between FOHR, TVI, and ETV success. CONCLUSIONS Assessing the IC angle and anterior TVH on preoperative and 24-hour postoperative MR images is useful for predicting the clinical success of ETV. These 2 measurements could also be valuable as radiological follow-up parameters.
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Affiliation(s)
- Mehmet Sabri Gürbüz
- 1Department of Neurosurgery, School of Medicine, İstanbul Medeniyet University
| | - Adnan Dağçınar
- 2Department of Neurosurgery, School of Medicine, Marmara University; and
| | - Yaşar Bayri
- 2Department of Neurosurgery, School of Medicine, Marmara University; and
| | - Aşkın Şeker
- 2Department of Neurosurgery, School of Medicine, Marmara University; and
| | - Hasan Güçlü
- 3Department of Biostatistics and Medical Informatics, School of Medicine, İstanbul Medeniyet University, İstanbul, Turkey
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Bruscella S, Solari D, Somma T, Barbato M, Gangemi M, Cavallo LM. Predicting endoscopic third ventriculostomy success in adult hydrocephalus: preliminary assessment of a modified ETV success score for adults (ETVSS-A) in a series of 47 patients. J Neurosurg Sci 2019; 66:33-39. [PMID: 31565904 DOI: 10.23736/s0390-5616.19.04712-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Endoscopic third ventriculostomy is an established treatment for noncommunicating hydrocephalus. In carefully selected patients, it can be adopted for the management of communicating variant; however controversy exists in regards to the definition of the appropriate candidates. Predictive score of Endoscopic Third Ventriculostomy Success (ETVSS) has been reported for pediatric and mixed populations only. Our purpose was to define a ETV success score for adult population (ETVSS-A), measuring the strength of correlation between preoperative score retrospectively evaluated and the success rates achieved in a class of adult patients. METHODS A retrospective analysis of 47 cases which received ETV procedure at our Institution between 2015 and 2018 was run. Demographic data,clinical history,preoperative and postoperative signs were reviewed and ETVSS-A was calculated. Thereafter ETVSS-A results were compared with the actual success rates. RESULTS 29 patients(61,7%) presented unchanged or improvedclinical status with a mean ETVSS-A of 54.5%;18 patients(38,3%) worsened with mean ETVSS-A of 37,7%. We found that age,type of hydrocephalus and symptoms of admission are each apart important factors in predicting ETV success:older patients and those with non-obstructive hydrocephalus had the lowest predicted ETV success. In patients in whom ETV was actually successful, the pre-operative ETVSS-A was significantly higher as compared to those patients in whom we observed a poor surgical outcome. CONCLUSIONS From the results of this series, though small and retrospectively analyzed, it seems that ETVSS-A can be considered as a useful instrument to help neurosurgeon in predicting the ETV success and though define a more accurate surgical strategy in cases of hydrocephalus. Wider series and prospective studies are attended to validate these preliminary results.
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Affiliation(s)
- Sara Bruscella
- Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Domenico Solari
- Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Naples, Italy -
| | - Teresa Somma
- Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Marcello Barbato
- Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Michelangelo Gangemi
- Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Luigi M Cavallo
- Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Naples, Italy
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Management of hydrocephalus after resection of posterior fossa lesions in pediatric and adult patients-predictors for development of hydrocephalus. Neurosurg Rev 2019; 43:1143-1150. [PMID: 31286305 DOI: 10.1007/s10143-019-01139-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/21/2019] [Accepted: 06/21/2019] [Indexed: 10/26/2022]
Abstract
The surgical management of hydrocephalus in patients with posterior fossa lesions (PFL) is critical for optimal patient outcome(s). Accordingly, it is prudent to identify patients in need of aggressive surgical intervention (i.e., ventriculoperitoneal [VP] shunting). To analyze prevalence of, and risk factors associated with, the development of post-operative hydrocephalus in both pediatrics and adults. A retrospective institutional analysis and review of patient records in those who had undergone PFL surgery was performed. In so doing, the authors identified patients that went on to develop post-operative hydrocephalus. The study included pediatric and adult patients treated between 2009 and 2017. Fifteen of 40 pediatric (37.5%) and 18 of 262 adult (6.9%) patients developed hydrocephalus after PFL surgery. The most common tumor entity in pediatrics was medulloblastoma (34%), astrocytoma (24.4%), and pilocytic astrocytoma (22%), whereas in adults, metastasis (29.5%), meningioma (22%), and acoustic neuroma (17.8%) were most common. Young age ≤ 2 years, medulloblastoma (OR 13.9), and brain stem compression (OR 5.4) were confirmed as independent predictors for hydrocephalus in pediatrics and pilocytic astrocytoma (OR 15.4) and pre-operative hydrocephalus (OR 3.6) in adults, respectively. All patients received VP shunts for hydrocephalus management and the mean follow-up was 29.5 months in pediatrics vs 19.2 months in adults. Overall complication rates related to VP shunts were 33.3% in pediatrics and 16.7% in adults, respectively. Shunt dependency and associated complications in pediatrics were noted to be higher than in adults. Given the identification of predictors for hydrocephalus, it is authors' contention that certain patients with those predictors may ultimately benefit from an alternative treatment regimen (e.g., pre-operative interventions) prior to PFT surgery.
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Endoscopic Third Ventriculostomy in Cases of Ventriculoperitoneal Shunt Malfunction: Does Shunt Duration Play a Role? World Neurosurg 2019; 127:e799-e808. [DOI: 10.1016/j.wneu.2019.03.268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 03/26/2019] [Accepted: 03/27/2019] [Indexed: 11/23/2022]
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