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Long-term control of hydrocephalus via endoscopic third ventriculostomy in children with tectal plate gliomas
John C Wellons1, R Shane Tubbs, Jason T Banks
1Section of Pediatric Neurosurgery, Children's Hospital of Alabama, Birmingham 35233, USA.
Insights
Endoscopic third ventriculostomy (ETV) effectively controlled hydrocephalus in children with tectal plate gliomas. This minimally invasive procedure led to shunt freedom and symptom resolution in all pediatric patients studied.
Area of Science:
- Pediatric Neurosurgery
- Neuro-oncology
- Minimally Invasive Neurological Surgery
Background:
- Hydrocephalus is a common complication of pediatric brain tumors, particularly tectal plate gliomas.
- Traditional management often involves cerebrospinal fluid (CSF) shunting, which carries risks of infection and malfunction.
- Endoscopic third ventriculostomy (ETV) offers a less invasive alternative for CSF diversion.
Observation:
- This study reviewed 13 pediatric patients diagnosed with tectal plate gliomas and hydrocephalus.
- Endoscopic third ventriculostomy (ETV) was the primary treatment for 12 of the 13 patients.
- The median follow-up period was 31 months, with a range of outcomes including successful secondary ETV and shunt removal.
Findings:
- All 13 children achieved shunt freedom following ETV.
- Symptoms and signs associated with hydrocephalus resolved in all patients.
- Postoperative imaging confirmed normal or reduced ventricular size in all cases.
Implications:
- ETV is a highly successful and safe treatment for hydrocephalus secondary to tectal plate gliomas in children.
- ETV should be considered the preferred initial treatment option for this patient population.
- This approach potentially reduces the long-term complications associated with CSF shunts.
Objective:
We report the control of hydrocephalus in children with presumed tectal plate gliomas by the use of endoscopic third ventriculostomy (ETV).
Methods:
The hospital records, office charts, and imaging studies from children who underwent ETV at the Children's Hospital of Alabama were reviewed. Thirteen children with the diagnosis of tectal plate glioma and hydrocephalus were identified. ETV was the primary therapy instituted for all but one of these children. Successful treatment outcome was defined as shunt freedom, improvement in symptoms, and reduced ventricular size.
Results:
Thirteen children underwent a total of 15 ETVs, and all children were shunt-free at their most recent follow-up examinations. One child underwent successful secondary ETV, one child underwent shunt removal concomitant with the initial ETV, and one child underwent shunt removal concomitant with secondary ETV. Symptoms and signs resolved in all patients. All postoperative cranial imaging studies revealed normal or reduced ventricular size as compared with preoperative cranial imaging scans. The median follow-up period was 31 months.
Conclusion:
In our surgical experience, ETV has been uniformly successful in the management of hydrocephalus caused by tectal plate gliomas in children. ETV should be considered the treatment of choice for hydrocephalus in pediatric patients with tectal plate gliomas.
