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Asadov RI, Bernard E, Enelis B. Endoscopic Ventriculocysternostomy, Magendie Foraminoplasty, and Plexusectomy With Craniovertebral Shunt Placement in a Pediatric Patient With Hydrocephalus and VACTERL Association: A Novel Treatment Option. Cureus 2024; 16:e58845. [PMID: 38784296 PMCID: PMC11115447 DOI: 10.7759/cureus.58845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2024] [Indexed: 05/25/2024] Open
Abstract
Endoscopic third ventriculocysternostomy (ETV) is a minimally invasive neurosurgical technique with good results in the treatment of obstructive hydrocephalus. The VACTERL (vertebrae, anorectal, cardiovascular, tracheal, esophageal, renal, limb defects) association, or VATER syndrome, is defined as congenital malformations, mostly derived from the mesoderm, affecting specific areas. It is diagnosed by the presence of at least three of the seven characteristic malformations that describe it. The association of this pathology and obstructive hydrocephalus in pediatric age is not common, making management and conventional neurosurgical procedures difficult due to the number of underlying pathologies. In this study, we report the management of hydrocephalus and VACTERL association with multiple congenital malformations in a 30-day-old premature neonate (birth at 29 weeks). Operations performed prior to admission to our service included: coloesophagoplasty and placement of esophagostoma in the left anterior cervical region, perineal anorectoplasty, gastrostomy and placement of sigmoidostomy in the left anterior abdominal wall, relaparotomy, gastric suture, sanitation, and abdominal drainage. Upon admission, the patient showed a Grade 3 intraventricular hemorrhage and internal occlusive hydrocephalus due to circulatory blockage of the cerebrospinal fluid (CSF) at the level of the outlet of the fourth ventricle. This was accompanied by intracranial hypertension and refractory cervical syringomyelia. We performed endoscopic ventriculocysternostomy plus plexusectomy plus Magendie foraminoplasty with craniovertebral shunt placement, achieving excellent results after two interventions. This is the first case described in the literature placing a craniovertebral shunt using a lateral-ventricle-to-the-subarachnoid-spinal-space-stenting technique in a patient with VACTERL association, which represents an innovation in the field of minimally invasive pediatric neurosurgery.
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Affiliation(s)
- Ruslan I Asadov
- Neurological Surgery, Scientific and Practical Center of Specialized Medical Care for Children Named After V.F. Voino-Yasenetsky of the Health Department of the City of Moscow, Moscow, RUS
| | - Edwin Bernard
- Neurosurgery, Russian University People's Friendship (RUDN) European Medical Centre (EMC) Medical School, Moscow, RUS
| | - Brenda Enelis
- Neurosurgery, Russian University People's Friendship (RUDN) European Medical Centre (EMC) Medical School, Moscow, RUS
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Zakaria Z, Ismail MI, Ang SY, Idris Z. Neuroradiological Correlation of the Lateral Third Periventricular, Pituitary Gland and Stalk, Pineal Gland, Cerebral Aqueduct, and Foramen Magendie and Luschka With Intraventricular Neuroendoscopic Images: A Case Series. Cureus 2024; 16:e56952. [PMID: 38665765 PMCID: PMC11044081 DOI: 10.7759/cureus.56952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Neuroendoscopy procedures in pediatrics have expanded beyond the endoscopic third ventriculostomy. As such, a direct and angled endoscope allows further visualization around the corner, capturing the surrounding anatomy. Intraoperative live images look different than radiological images. Hence, in this single institutional experience, we correlate neuroradiology images with intraoperative intraventricular endoscopic views of the third-fourth ventricle, pituitary, pineal gland, cerebral aqueduct, and foramen magendie and luschka. Our collective case series reveals a few interesting case scenarios of normal and abnormal findings during the procedure. Careful navigation of the neuroendoscope is crucial to prevent injury to the neurovascular bundle. A close relationship with normal anatomy from radiological imaging is necessary to prevent it from getting lost once inside the ventricular cavity.
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Affiliation(s)
- Zaitun Zakaria
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia (USM), Kota Bharu, MYS
| | - Muhammad Ihfaz Ismail
- Department of Neurosciences, Hospital UniversitI Sains Malaysia (HUSM), Kota Bharu, MYS
| | - Song Yee Ang
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia (USM), Kota Bharu, MYS
| | - Zamzuri Idris
- Department of Neurosciences, School of Medical Sciences, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia (USM), Kota Bharu, MYS
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3
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Issa M, Younsi A, Paggetti F, Miotk N, Seitz A, Bendszus M, Wisoff JH, Unterberg A, El Damaty A. Heidelberg ETV score to assess success of ETV in patients with occlusive hydrocephalus: a retrospective single-center study. Neurosurg Rev 2023; 46:214. [PMID: 37644240 PMCID: PMC10465657 DOI: 10.1007/s10143-023-02122-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/13/2023] [Accepted: 08/15/2023] [Indexed: 08/31/2023]
Abstract
In aqueduct stenosis, pressure difference below and above level of obstruction leads to bulging of third ventricular floor (TVF) and lamina terminalis (LT). Endoscopic third ventriculocisternostomy (ETV) is the standard treatment in these patients. We tried to assess success of ETV depending on those two radiological changes in aqueduct stenosis. We implemented "Heidelberg ETV score" retrospectively to assess the state of TVF as well as LT in same manner in midsagittal MR image. Every patient had a preoperative, direct, 3-months and one-year postoperative score from -2 to + 2. We correlated the scores to clinical course to decide whether the score is reliable in defining success of ETV. Between 2017-2021, 67 (mean age 25.6 ± 23.9y) patients treated with ETV were included. Success rate of primary and Re-ETVs was 91% over 46.8 ± 19.0 months. A marked shift of score to the left after surgery in success group was noticed through the distribution of score immediate postoperative, 3-months later; 70.2% showed (+ 2) before surgery, 38.9% scored (0) after surgery and 50.9% showed further score drop to (-1) 3 months later, p < 0.001. In cases of failure, there was initial decrease after surgery followed by increase with ETV-failure (mean time to failure: 7.2 ± 5.7 months) in 100%. Significant difference was noticed in Heidelberg score at postoperative 1-year- and failure-MRI follow-up between two groups, p < 0.001. Heidelberg score describes anatomical changes in third ventricle after ETV and can serve in assessment of MR images to define success of the procedure in patients with aqueduct stenosis.
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Affiliation(s)
- Mohammed Issa
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Alexander Younsi
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Filippo Paggetti
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Nikolai Miotk
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Angelika Seitz
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jeffrey H Wisoff
- Department of Neurosurgery, Division of Pediatric Neurosurgery, The Hassenfeld Children's Hospital at NYU Langone Health, New York City, NY, USA
| | - Andreas Unterberg
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Ahmed El Damaty
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
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Kim KH, Shim Y, Lee JY, Phi JH, Koh EJ, Kim SK. Clinical Outcome of Endoscopic Procedure in Patients with Shunt Malfunction. J Korean Neurosurg Soc 2023; 66:162-171. [PMID: 36755510 PMCID: PMC10009242 DOI: 10.3340/jkns.2022.0089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/27/2022] [Indexed: 02/10/2023] Open
Abstract
OBJECTIVE The goal of this study was to analyze the clinical outcomes of endoscopic third ventriculostomy (ETV) and endoscopic septostomy when shunt malfunction occurs in a patient who has previously undergone placement of a ventriculoperitoneal shunt. METHODS From 2001 to 2020 at Seoul National University Children's Hospital, patients who underwent ETV or endoscopic septostomy for shunt malfunction were retrospectively analyzed. Initial diagnosis (etiology of hydrocephalus), age at first shunt insertion, age at endoscopic procedure, magnetic resonance or computed tomography image, subsequent shunting data, and follow-up period were included. RESULTS Thirty-six patients were included in this retrospective study. Twenty-nine patients, 18 males and 11 females, with shunt malfunction underwent ETV. At the time of shunting, the age ranged from 1 day to 15.4 years (mean, 2.4 years). The mean age at the time of ETV was 13.1 years (range, 0.7 to 29.6 years). Nineteen patients remained shunt revision free. The 5-year shunt revisionfree survival rate was 69% (95% confidence interval [CI], 0.54-0.88). Seven patients, three males and four females, with shunt malfunction underwent endoscopic septostomy. At the time of shunting, the age ranged from 0.2 to 12 years (mean, 3.9 years). The mean age at the time of endoscopic septostomy was 11.9 years (range, 0.5 to 29.5 years). Four patients remained free of shunt revision or addition. The 5-year shunt revision-free survival rate was 57% (95% CI, 0.3-1.0). There were no complications associated with the endoscopic procedures. CONCLUSION The results of our study demonstrate that ETV or endoscopic septostomy can be effective and safe in patients with shunt malfunction.
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Affiliation(s)
- Kyung Hyun Kim
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Korea.,Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Youngbo Shim
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Korea.,Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Yeoun Lee
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Korea.,Department of Anatomy and Cell Biology, Seoul National University College of Medicine, Seoul, Korea.,Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Hoon Phi
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Korea.,Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Jung Koh
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Korea.,Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Ki Kim
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Korea.,Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Rocque BG, Jensen H, Reeder RW, Kulkarni AV, Pollack IF, Wellons JC, Naftel RP, Jackson EM, Whitehead WE, Pindrik JA, Limbrick DD, McDonald PJ, Tamber MS, Hankinson TC, Hauptman JS, Krieger MD, Chu J, Simon TD, Riva-Cambrin J, Kestle JRW, Rozzelle CJ. Endoscopic third ventriculostomy in previously shunt-treated patients. J Neurosurg Pediatr 2022; 30:428-436. [PMID: 35907200 PMCID: PMC9884313 DOI: 10.3171/2022.6.peds22177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/30/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Endoscopic third ventriculostomy (ETV) is an option for treatment of hydrocephalus, including for patients who have a history of previous treatment with CSF shunt insertion. The purpose of this study was to report the success of postshunt ETV by using data from a multicenter prospective registry. METHODS Prospectively collected data in the Hydrocephalus Clinical Research Network (HCRN) Core Data Project (i.e., HCRN Registry) were reviewed. Children who underwent ETV between 2008 and 2019 and had a history of previous treatment with a CSF shunt were included. A Kaplan-Meier survival curve was created for the primary outcome: time from postshunt ETV to subsequent CSF shunt placement or revision. Univariable Cox proportional hazards models were created to evaluate for an association between clinical and demographic variables and subsequent shunt surgery. Postshunt ETV complications were also identified and categorized. RESULTS A total of 203 children were included: 57% male and 43% female; 74% White, 23% Black, and 4% other race. The most common hydrocephalus etiologies were postintraventricular hemorrhage secondary to prematurity (56, 28%) and aqueductal stenosis (42, 21%). The ETV Success Score ranged from 10 to 80. The median patient age was 4.1 years. The overall success of postshunt ETV at 6 months was 41%. Only the surgeon's report of a clear view of the basilar artery was associated with a lower likelihood of postshunt ETV failure (HR 0.43, 95% CI 0.23-0.82, p = 0.009). None of the following variables were associated with postshunt ETV success: age at the time of postshunt ETV, etiology of hydrocephalus, sex, race, ventricle size, number of previous shunt operations, ETV performed at time of shunt infection, and use of external ventricular drainage. Overall, complications were reported in 22% of patients, with CSF leak (8.6%) being the most common complication. CONCLUSIONS Postshunt ETV was successful in treating hydrocephalus, without subsequent need for a CSF shunt, in 41% of patients, with a clear view of the basilar artery being the only variable significantly associated with success. Complications occurred in 22% of patients. ETV is an option for treatment of hydrocephalus in children who have previously undergone shunt placement, but with a lower than expected likelihood of success.
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Affiliation(s)
- Brandon G. Rocque
- Department of Neurosurgery, Children’s of Alabama, The University of Alabama at Birmingham, Alabama
| | - Hailey Jensen
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Ron W. Reeder
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Abhaya V. Kulkarni
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ian F. Pollack
- Department of Neurosurgery, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh, Pennsylvania
| | - John C. Wellons
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
- Surgical Outcomes Center for Kids, Monroe Carell Jr. Children’s Hospital at Vanderbilt University, Nashville, Tennessee
| | - Robert P. Naftel
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
- Surgical Outcomes Center for Kids, Monroe Carell Jr. Children’s Hospital at Vanderbilt University, Nashville, Tennessee
| | - Eric M. Jackson
- Department of Neurosurgery, The Johns Hopkins Hospital, Johns Hopkins University, Baltimore, Maryland
| | | | - Jonathan A. Pindrik
- Department of Neurosurgery, The Ohio State University College of Medicine, Columbus, Ohio
| | - David D. Limbrick
- Department of Neurosurgery, Washington University School of Medicine in St. Louis, Missouri
| | - Patrick J. McDonald
- Division of Neurosurgery, British Columbia Children’s Hospital, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Mandeep S. Tamber
- Division of Neurosurgery, British Columbia Children’s Hospital, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Todd C. Hankinson
- Department of Neurosurgery, Children’s Hospital Colorado, Colorado Springs, Colorado
| | - Jason S. Hauptman
- Department of Neurosurgery, Seattle Children’s Hospital, University of Washington, Seattle, Washington
| | - Mark D. Krieger
- Department of Neurosurgery, Children’s Hospital Los Angeles, University of Southern California, Los Angeles, California
| | - Jason Chu
- Department of Neurosurgery, Children’s Hospital Los Angeles, University of Southern California, Los Angeles, California
| | - Tamara D. Simon
- Department of Pediatrics, Children’s Hospital Los Angeles, University of Southern California, Los Angeles, California
| | - Jay Riva-Cambrin
- Division of Neurosurgery, Alberta Children’s Hospital, University of Calgary, Alberta, Canada
| | - John R. W. Kestle
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Curtis J. Rozzelle
- Department of Neurosurgery, Children’s of Alabama, The University of Alabama at Birmingham, Alabama
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Panagopoulos D, Karydakis P, Themistocleous M. Slit ventricle syndrome: Historical considerations, diagnosis, pathophysiology, and treatment review. Brain Circ 2021; 7:167-177. [PMID: 34667900 PMCID: PMC8459697 DOI: 10.4103/bc.bc_29_21] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 05/08/2021] [Accepted: 05/21/2021] [Indexed: 11/06/2022] Open
Abstract
After the introduction of shunt treatment for the management of childhood hydrocephalus, a wide variety of complications related to this treatment modality have been recognized. The entity of slit ventricle syndrome (alternatively, symptomatic ventricular coaptation) is one of them, is frequently encountered in the pediatric population and its symptom complex resembles that of shunt failure. We conducted research on PubMed®, MEDLINE®, and Web of Science®, using the keywords: “slit ventricles,” “slit ventricle syndrome,” “SVS” and “ventricular coaptation.” The aim of our review was to trace the advances made through the past decades, concerning our knowledge about the clinical characteristics, pathophysiology, and treatment options of this entity. The discrepancy among researchers about the offending etiology and the optimum treatment algorithm of this entity, as well as the necessity of an updated concept regarding shunt over drainage is analyzed. The multiple treatment modalities proposed and pathophysiologic mechanisms implicated for the treatment of slit ventricle syndrome illustrate the complexity of this entity. Consequently, the issue requires more detailed evaluation. In this review, we comment on all the main facets related to shunt over drainage and the resultant slit ventricle syndrome.
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Affiliation(s)
- Dimitrios Panagopoulos
- Department of Neurosurgery, Pediatric Hospital of Athens, "Agia Sophia,", Athens, Greece
| | | | - Marios Themistocleous
- Department of Neurosurgery, Pediatric Hospital of Athens, "Agia Sophia,", Athens, Greece
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Muroi A, Quezada JJ, McComb JG. Usefulness of postoperative ventriculography and intracranial pressure monitoring following endoscopic third ventriculostomy. Childs Nerv Syst 2021; 37:1151-1158. [PMID: 33241438 DOI: 10.1007/s00381-020-04981-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/19/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE The authors sought to determine whether the insertion of an external ventricular drain (EVD) at the time of surgery to monitor intracranial pressure (ICP) and ventriculography done within the first day following an endoscopic third ventriculostomy (ETV) is of benefit in postoperative patient management. METHODS Following IRB approval, ETV procedures done by the senior author between January 1, 2007, and December 31, 2016, were reviewed. Included in a consecutive fashion were all patients who underwent an ETV with placement of an external ventricular drain (EVD) that was preceded preoperatively by an MRI or CT study and followed by a contrast CT ventriculogram within the first postoperative day. RESULTS Identified were 72 patients who met the above criteria; however, technical ventriculography failure occurred in 4 (6%) and were eliminated from the analysis. Of the remaining 68 patients, contrasted CSF was seen in the basal cisterns/subarachnoid spaces (SAS) in 66 (97%) indicating a patent ETV and absent in 2 (3%) indicating a non-patent ETV. Of the 66 patients with a patent ETV, 34 (52%) patients were discharged on postoperative days 1 (8), 2 (13), and 3 (13) as their ICPs were not elevated and their clinical symptoms normal. EVDs placed at the time of the ETV recorded raised ICP > 20 cm H2O in 17/68 (25%) patients for 1 or more days, all of whom had a patent ETV. Because of persistently elevated ICP requiring CSF drainage for control, 4 of these patients were shunted on postoperative days 5, 6, 6, and 10 and 3 with prolonged elevated ICP for 5, 6, and 11 days postoperatively were not shunted as their ICP and symptoms progressively normalized. The remaining 17/68 (25%) patients did not have a postoperative ICP > 20 cm H2O; 14 were discharged after resolution of symptoms and other clinical factors, 1 was shunted on postoperative day 3 due to persistent symptoms and a consistently large volume of CSF drainage, and 2 had a non-patent ETV with 1 undergoing shunt placement and the other discharged because of the absence of symptoms. The sensitivity of ventriculography was only 13%; however, the specificity was 98% and the accuracy 88%. CONCLUSION After reviewing this series, the continued use of a postoperative EVD appears appropriate as the risk is low and it provides ventricular access to control ICP, thereby, improving patients' safety and reducing the need for CSF shunting on an urgent/emergent basis should the ETV prove to be unsuccessful. From our limited series, the usefulness of a 1-day postoperative ETV ventriculogram is less clear and would need confirmation with additional studies.
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Affiliation(s)
- Ai Muroi
- Department of Neurosurgery, University of Tsukuba, Tennoudai, Tsukuba, Ibaraki, Japan
| | - Jeffrey J Quezada
- Division of Neurosurgery, Children's Hospital Los Angeles, 1300 N. Vermont Ave. Suite 1006, Los Angeles, CA, 90027, USA
| | - J Gordon McComb
- Division of Neurosurgery, Children's Hospital Los Angeles, 1300 N. Vermont Ave. Suite 1006, Los Angeles, CA, 90027, USA. .,Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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8
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Takeshige N, Uchikado H, Nakashima D, Negoto T, Nagase S, Yoshitomi M, Sakata K, Morioka M. Endoscopic third ventriculostomy for myelomeningocele-related hydrocephalus after shunt failure: Long-term outcome in a series of 8 patients. Clin Neurol Neurosurg 2020; 201:106406. [PMID: 33341457 DOI: 10.1016/j.clineuro.2020.106406] [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: 09/21/2020] [Revised: 12/01/2020] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Endoscopic third ventriculostomy (ETV) has now become an accepted mode of hydrocephalus treatment. However, the long-term effects of ETV for myelomeningocele-related hydrocephalus (MMC-rH) after shunt malfunction remains unclear. We aimed to assess the long-term outcome and the factors associated with the success of ETV for MMC-rH after shunt malfunction. METHODS We performed a retrospective analysis of data collected between 2001 and 2018 from 8 patients with MMC-rH after shunt malfunction, who underwent ETV at the Kurume University Hospital and were followed up for at least 5 years. We extracted data regarding age, sex, clinical symptoms, radiological imaging, intraoperative findings, and outcomes. RESULTS The overall success rate was 62.5% and their ETV success score is 67.5. The most frequent clinical symptom was intracranial hypertension symptoms (100 %), followed by Chiari type II symptoms (87.5 %). In preoperative MRI scans, we observed aqueduct stenosis in 6 cases, Chiari type II malformations in 7 cases, four patients had a narrow prepontine cistern, five patients had an absent septum pellucidum, and three presented with stenosis of the foramen of Monro. All cases in the failure group had the above 5 symptoms. Based on intraoperative findings, a thick third ventricle floor was found in 5 patients. Two patients had a thin hypothalamic adhesion in the third ventricle floor. They had no major complications. CONCLUSION ETV for MMC-rH after shunt malfunction is an effective treatment option. However, we recommend that a neurosurgeon with extensive experience in neuroendoscopy perform ETV because MMC patients more often had intraventricular malformations than those with other hydrocephalus diseases.
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Affiliation(s)
- Nobuyuki Takeshige
- Departments of Neurosurgery, Kurume University School of Medicine, Kurume, Fukuoka Prefecture, Japan.
| | - Hisaaki Uchikado
- Departments of Neurosurgery, Kurume University School of Medicine, Kurume, Fukuoka Prefecture, Japan; Uchikado Neuro-Spine Clinic, Fukuoka, Fukuoka Prefecture, Japan
| | - Daisuke Nakashima
- Departments of Neurosurgery, Kurume University School of Medicine, Kurume, Fukuoka Prefecture, Japan
| | - Tetsuya Negoto
- Departments of Neurosurgery, Kurume University School of Medicine, Kurume, Fukuoka Prefecture, Japan
| | - Satoshi Nagase
- Departments of Neurosurgery, Kurume University School of Medicine, Kurume, Fukuoka Prefecture, Japan
| | - Munetake Yoshitomi
- Departments of Neurosurgery, Kurume University School of Medicine, Kurume, Fukuoka Prefecture, Japan
| | - Kiyohiko Sakata
- Departments of Neurosurgery, Kurume University School of Medicine, Kurume, Fukuoka Prefecture, Japan
| | - Motohiro Morioka
- Departments of Neurosurgery, Kurume University School of Medicine, Kurume, Fukuoka Prefecture, Japan
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9
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Gorgoglione N, Fazzari E, Alafaci C, Vitulli F, Zaccaria R, Angileri FF, Germanò A, Esposito F. An Unusual But Possible Complication After Endoscopic Third Ventriculostomy. World Neurosurg 2020; 146:287-291. [PMID: 33276175 DOI: 10.1016/j.wneu.2020.11.149] [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: 04/15/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND We present an unusual but possible complication after ETV for the treatment of acute hydrocephalus due to malfunction of a previously implanted V-P shunt. CASE DESCRIPTION A 12-year-old male patient was urgently operated upon by means of an endoscopic third-ventriculostomy and the positioning of a temporary external ventricular catheter because of the malfunction of a previously implanted V-P shunt; immediately after the operation, the tip of the external catheter caused an obstruction of the ostomy, which was resolved with the withdrawn of catheter for circa 1 cm, left closed and ultimately removed after 4 days. The patient did not present any further symptom and remained shunt-free at the last 2-year follow-up visit. CONCLUSIONS One should consider such occurrence in cases of early ETV failure when a ventricular catheter is left in situ, even though temporarily.
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Affiliation(s)
- Nicola Gorgoglione
- Division of Neurosurgery, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - Elena Fazzari
- Division of Neurosurgery, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - Concetta Alafaci
- Division of Neurosurgery, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - Francesca Vitulli
- Division of Neurosurgery, Department of Neurosciences and Reproductive and Dental Sciences, Federico II University of Naples, Napoli, Italy
| | - Rossella Zaccaria
- Division of Neurosurgery, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - Filippo F Angileri
- Division of Neurosurgery, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - Antonino Germanò
- Division of Neurosurgery, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - Felice Esposito
- Division of Neurosurgery, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy; Division of Neurosurgery, Department of Neurosciences and Reproductive and Dental Sciences, Federico II University of Naples, Napoli, Italy.
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10
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Yamamoto T, Takeuchi K, Nagata Y, Mizuno A, Wakabayashi T. Novel Endoscopic Technique for Inserting a Sheath into a Slit Ventricle: The Water-Slide Technique. World Neurosurg 2020; 145:1-4. [PMID: 32891843 DOI: 10.1016/j.wneu.2020.08.206] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The efficacy and safety of endoscopic procedures for slit ventricle syndrome (SVS) have been presented in recent studies. However, inserting a sheath into a target ventricle is essential in the beginning of endoscopic procedures for SVS, and this maneuver is challenging owing to the quite narrow ventricular space. We report a novel flexible endoscopic technique, the water-slide technique, that can effectively guide a sheath into a slit ventricle without the use of other adjunctive devices, such as a neuronavigation system and an ultrasound machine. METHODS Ten endoscopic procedures using the water-slide technique were performed in 9 patients with SVS. All patients had undergone ventriculoperitoneal shunt placement. Using the technique, the sheath was first placed on the flexible endoscope. The endoscope was then inserted into the lateral ventricle along the tract around the pre-existing ventricular catheter with irrigation of artificial cerebrospinal fluid via the working channel of the endoscope. After the endoscope reached the ventricle, the sheath was inserted into the ventricle along the endoscope. The endoscope was then used as a stylet. The endoscopic procedure was performed afterward. Continuous irrigation of artificial cerebrospinal fluid via the working channel is important when using this technique. RESULTS In all cases, the sheath was successfully introduced to the slit ventricle without the use of adjunctive devices. There were no postoperative complications correlated with the maneuver. CONCLUSIONS This novel endoscopic technique is effective and safe for inserting a sheath into a target ventricle in the management of SVS.
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Affiliation(s)
- Taiki Yamamoto
- Department of Neurosurgery, Nagoya University, Nagoya, Japan.
| | | | - Yuichi Nagata
- Department of Neurosurgery, Nagoya University, Nagoya, Japan
| | - Akihiro Mizuno
- Department of Neurosurgery, Nagoya University, Nagoya, Japan
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The role of external ventricular drainage for the management of posterior cranial fossa tumours: a systematic review. Neurosurg Rev 2020; 44:1243-1253. [PMID: 32494987 DOI: 10.1007/s10143-020-01325-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 05/20/2020] [Accepted: 05/25/2020] [Indexed: 10/24/2022]
Abstract
Posterior cranial fossa tumours frequently develop hydrocephalus as first presentation in up to 80% of paediatric patients and 21.4% of adults, although it resolves after tumour removal in 70-90% and 96%, respectively. New onset hydrocephalus is reported in about 2.1% of adult and 10-40% of paediatric patients after posterior fossa surgery. There is no consensus concerning prophylactic external ventricular drainage (EVD) placement that is frequently used before posterior fossa lesion removal, as well in those cases without clear evidence of hydrocephalus. The aim of the study was to define the most correct management for patients who undergo posterior fossa tumour surgery, thus identifying cohorts of patients who are at risk of persistent hydrocephalus prior to surgery. A systematic review of literature has been performed, following PRISMA guidelines. Most of the studies reported CSF shunt only in the presence of hydrocephalus, whereas only a few authors suggested its prophylactic use in the absence of signs of ventricular dilatation. Predictive factors for postoperative hydrocephalus has been identified, including young age (< 3 years), severe symptomatic hydrocephalus at presentation, EVD placement before surgery, FOHR index > 0.46 and Evans index > 0.4, pseudomeningocele, CSF leak and infection. The use of pre-resection CSF shunt in case of signs and symptoms of hydrocephalus is mandatory, although it resolves in the majority of cases. As reported by several studies included in the present review, we suggest CSF shunt also in case of asymptomatic hydrocephalus, whereas it is not indicated without evidence of ventricular dilatation.
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12
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Weeks SR, Gosztyla CE, Davidson L, Pryor HI. Innovative approach to the difficult ventricular shunt using pleural access device for maintenance drainage: case report. J Neurosurg Pediatr 2020; 25:407-410. [PMID: 31899886 DOI: 10.3171/2019.10.peds19122] [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: 06/06/2019] [Accepted: 10/15/2019] [Indexed: 11/06/2022]
Abstract
Patients with complex medical problems and multiple failed ventricular shunts require continued innovation for hydrocephalus management. The authors report the case of a 4-year-old boy with refractory hydrocephalus and secondary reduced ability to absorb CSF in both the pleural and peritoneal cavities following renal transplantation. A novel management approach was devised with split shunting to pleural and peritoneal targets as well as prophylactic pleural port placement to provide a method for minimally invasive thoracentesis should symptomatic pleural effusions develop. Fluid was successfully aspirated via the pleural port with relief of symptoms over a period of 16 months without complication. The authors demonstrate that a previously undescribed approach to distal shunting can prevent neurological sequelae of shunt failure and permit noninvasive maintenance drainage for patients in whom symptomatic pleural effusion is a recurrent complication.
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Affiliation(s)
| | | | | | - Howard I Pryor
- 3Pediatric Surgery, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, Maryland
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13
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Hersh DS, Dave P, Weeks M, Hankinson TC, Karimian B, Staulcup S, Van Poppel MD, Wait SD, Vaughn BN, Klimo P. Converting Pediatric Patients and Young Adults From a Shunt to a Third Ventriculostomy: A Multicenter Evaluation. Neurosurgery 2019; 87:285-293. [DOI: 10.1093/neuros/nyz478] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 08/18/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Endoscopic third ventriculostomy (ETV) is an effective primary treatment for certain forms of hydrocephalus. However, its use in children with an existing shunt is less well known.
OBJECTIVE
To report a multicenter experience in attempting to convert patients from shunt dependence to a third ventriculostomy and to determine predictors of success.
METHODS
Three participating centers provided retrospectively collected information on patients with an attempted conversion from a shunt to an ETV between December 1, 2008, and April 1, 2018. Demographic, clinical, and radiological data were recorded. Success was defined as shunt independence at the last follow-up.
RESULTS
Eighty patients with an existing ventricular shunt underwent an ETV. The median age at the time of the index ETV was 9.9 yr, and 44 (55%) patients were male. The overall success rate was 64% (51/80), with a median duration of follow-up of 2.0 yr (range, 0.1-9.4 yr). Four patients required a successful repeat ETV at a median of 1.7 yr (range, 0.1-5.7 yr) following the index ETV. Only age was predictive of ETV failure on multivariate analysis (odds ratio 0.86 [95% CI 0.78-0.94], P = .005). No patient less than 6 mo of age underwent an ETV, and of the 5 patients between 6 and 12 mo of age, 4 failed.
CONCLUSION
Although not every shunted patient will be a candidate for an ETV, nor will they be successfully converted, an ETV should at least be considered in every child who presents with a shunt malfunction or who has an externalized shunt.
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Affiliation(s)
- David S Hersh
- Department of Neurosurgery, The University of Tennessee Health Science Center, The University of Tennessee, Memphis, Tennessee
| | | | | | - Todd C Hankinson
- Department of Neurosurgery, Anschutz Medical Campus, University of Colorado, Aurora, Colorado
- Children's Hospital Colorado, Aurora, Colorado
| | - Brandon Karimian
- Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina
| | - Susan Staulcup
- Department of Neurosurgery, Anschutz Medical Campus, University of Colorado, Aurora, Colorado
- Children's Hospital Colorado, Aurora, Colorado
| | - Mark D Van Poppel
- Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina
- Levine Children's Hospital, Charlotte, North Carolina
| | - Scott D Wait
- Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina
- Levine Children's Hospital, Charlotte, North Carolina
| | | | - Paul Klimo
- Department of Neurosurgery, The University of Tennessee Health Science Center, The University of Tennessee, Memphis, Tennessee
- Le Bonheur Children's Hospital, Memphis, Tennessee
- Semmes Murphey Clinic, Memphis, Tennessee
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14
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Iglesias S, Ros B, Ibáñez G, Delgado A, Ros Á, Arráez MÁ. Shunt independence in paediatric hydrocephalus: our 16-year experience and review. Childs Nerv Syst 2019; 35:1547-1555. [PMID: 31250092 DOI: 10.1007/s00381-019-04267-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 06/18/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Shunt independence remains a matter of debate for neurosurgeons, and little information on this subject is available in the literature. The aims of the study were to analyse the incidence of shunt removal in a series of paediatric patients and to describe our experience with attempts at shunt removal. METHODS Thirty of 212 paediatric patients shunted between 2000 and 2016 at our institution were studied for shunt independence. Variables related to hydrocephalus aetiology, shunt complications, independence trial peculiarities and follow-up were recorded and a descriptive analysis of the data was performed. RESULTS Two patients (0.94%) refused to be included in a shunt independence trial and were analysed separately. In the other 28 patients, 29 shunt independence trials were performed, of which 19 (65.52%) were successful, giving a global rate of shunt independence of 8.96% (19/212) in our population. Secondary endoscopic third ventriculostomy was the most frequent type of independence trial and achieved the highest success rate (75%). Spontaneous independence was achieved in just 4/7 cases (57.14%). Planned removal of the shunt in overdrainage cases had a 50% success rate, with transient measures to control intracranial pressure frequently required. CONCLUSIONS Shunt independence trials should be considered for selected patients in a closely monitored setting. Secondary endoscopic third ventriculostomy at the time of shunt malfunction has the highest success rate whereas planned removal of the shunt in overdrainage is an invasive procedure with more likelihood of failure. Shunt independence should not be presumed.
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Affiliation(s)
- Sara Iglesias
- Neurosurgery Department, Hospital Regional Universitario de Málaga, Avenida de Carlos Haya s/n, 29010, Málaga, Spain.
| | - Bienvenido Ros
- Neurosurgery Department, Hospital Regional Universitario de Málaga, Avenida de Carlos Haya s/n, 29010, Málaga, Spain
| | - Guillermo Ibáñez
- Neurosurgery Department, Hospital Regional Universitario de Málaga, Avenida de Carlos Haya s/n, 29010, Málaga, Spain
| | - Andrea Delgado
- Neurosurgery Department, Hospital Regional Universitario de Málaga, Avenida de Carlos Haya s/n, 29010, Málaga, Spain
| | - Ángela Ros
- Neurosurgery Department, Hospital Regional Universitario de Málaga, Avenida de Carlos Haya s/n, 29010, Málaga, Spain
| | - Miguel Ángel Arráez
- Neurosurgery Department, Hospital Regional Universitario de Málaga, Avenida de Carlos Haya s/n, 29010, Málaga, Spain
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15
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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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16
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Silva Neto AR, Uruguay ALR, Paiva DS, Silva ALP, Godeiro AHM, Eberlin LMN. Neurogenic Bladder Dysfunction as Signal of Late Failure of Endoscopic Third Ventriculostomy in Child with Spina Bifida. World Neurosurg 2019; 128:454-457. [PMID: 31132484 DOI: 10.1016/j.wneu.2019.05.138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/15/2019] [Accepted: 05/16/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Endoscopic third ventriculostomy (ETV) is an option for hydrocephalus treatment in patients with myelomeningocele, mostly after a previous shunt dysfunction. Late failure of ETV is a rare event, traditionally associated with dramatic symptoms of intracranial hypertension. In patients with myelodysplasia and neurogenic bladder dysfunction, urodynamic deterioration can be a signal of neurologic worsening as a consequence of tethered cord or shunt problems. CASE DESCRIPTION We describe here a rare case of a 12-year-old female patient with myelomeningocele and evidence of a failure 10 years after a previously successful ETV whose initial symptoms were worsening of urinary complaints. After 2 months, she was admitted to the emergency department with seizures and acute hydrocephalus and was shunted. CONCLUSIONS Pediatric neurosurgeons must follow myelomeningocele patients with successful ETV for a long time and take care of subtle alterations of organic functions that have a close relationship with central nervous system integrity. A multidisciplinary approach can facilitate this strategy and avoid a tragic outcome.
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Affiliation(s)
- Angelo R Silva Neto
- Pediatric Neurosurgery, Hospital Universitário Onofre Lopes, Natal, Brazil; Department of Integrated Medicine, Federal University of Rio Grande do Norte, Natal, Brazil; Santos Dumont Institute, Macaíba, Brazil.
| | - Ana Luíza R Uruguay
- Department of Integrated Medicine, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Damácio S Paiva
- Department of Integrated Medicine, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Alice L P Silva
- Department of Integrated Medicine, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Arthur H M Godeiro
- Department of Integrated Medicine, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Letícia M N Eberlin
- Department of Integrated Medicine, Federal University of Rio Grande do Norte, Natal, Brazil
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