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Related Experiment Videos

Failed endoscopic third ventriculostomy in children: management options.

Aaron Mohanty1, M K Vasudev, S Sampath

  • 1Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India. aarmohanty@yahoo.com

Pediatric Neurosurgery
|November 8, 2002
PubMed
Summary

Endoscopic third ventriculostomy (ETV) failure in obstructive hydrocephalus can be managed with MRI and endoscopic exploration. Identifying stoma patency guides treatment, often requiring a ventriculoperitoneal shunt (VPS) or repeat ETV.

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Area of Science:

  • Neurosurgery
  • Medical Imaging
  • Pediatric Neurology

Background:

  • Endoscopic third ventriculostomy (ETV) is a common treatment for obstructive hydrocephalus.
  • ETV has a significant failure rate, ranging from 20-50% in various studies.
  • Effective management strategies for ETV failure are crucial.

Purpose of the Study:

  • To analyze the causes and outcomes of ETV failure in obstructive hydrocephalus.
  • To outline a management plan for patients experiencing ETV failure.
  • To evaluate the role of MRI and endoscopic exploration in managing ETV failure.

Main Methods:

  • Retrospective analysis of 72 patients who underwent ETV over a 2-year period.
  • Clinical assessment and MRI with flow studies (T2 fast spin echo or 2D phase contrast) for patients with ETV failure.

Related Experiment Videos

  • Endoscopic exploration for patients with no demonstrable flow on MRI.

    • Main Results:

    • ETV failed in 13 out of 72 patients, with failures occurring within 1 month (7), 1-2 months (5), or delayed up to 2 years (1).
    • MRI showed no flow in 12 patients; one patient had good flow.
    • Endoscopic exploration revealed a patent stoma in 7 patients (requiring VPS) and a gliosis-closed stoma in 5 patients (undergoing repeat ETV).

    Conclusions:

    • MRI with flow studies is essential for diagnosing ETV failure.
    • Endoscopic exploration is indicated when MRI shows no flow.
    • Repeat ETV is suitable for closed stomas, while patent stomas may necessitate a ventriculoperitoneal shunt (VPS).