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Endoscopic third ventriculostomy in previously shunted children
Eva Brichtova1, Martin Chlachula, Tomas Hrbac
1Clinic of Pediatric Surgery, Orthopaedics and Traumatology, Brno Faculty Hospital, Cernopolni 9, 62500 Brno, Czech Republic.
Insights
Endoscopic third ventriculostomy (ETV) offers a 69% success rate for treating obstructive hydrocephalus in pediatric patients previously shunted. This neurosurgical procedure is a viable alternative to shunt revision, even in complex cases.
Area of Science:
- Neurosurgery
- Pediatric Neurology
Background:
- Obstructive hydrocephalus requires timely intervention.
- Ventriculoperitoneal (V-P) shunts are a common treatment but can fail.
- Endoscopic third ventriculostomy (ETV) is an alternative therapeutic option.
Purpose of the Study:
- To evaluate the success rate of ETV in pediatric patients with obstructive hydrocephalus who had prior V-P shunt implantation.
- To assess the feasibility of V-P shunt removal after successful ETV.
Main Methods:
- A retrospective study of 42 pediatric patients who underwent ETV between 2001 and 2011 after V-P shunt implantation.
- V-P shunts were temporarily clipped during ETV; removal was considered if clinical status and stoma function were favorable at 3 months.
- Magnetic resonance imaging (MRI) was used to confirm ventricular system obstruction.
Main Results:
- ETV was successful in 29 out of 42 patients (69%).
- V-P shunt removal was possible in successful cases.
- Two serious complications (4.7%) occurred, including delayed ETV failure leading to mortality in two patients.
Conclusions:
- ETV is a successful treatment for obstructive hydrocephalus, even in patients with a history of V-P shunt placement.
- ETV should be considered the primary endoscopic approach for obstructive hydrocephalus, offering a potential alternative to shunt revision.
- MRI can identify candidates for ETV during V-P shunt evaluation.
Abstract:
Endoscopic third ventriculostomy (ETV) is a routine and safe procedure for therapy of obstructive hydrocephalus. The aim of our study is to evaluate ETV success rate in therapy of obstructive hydrocephalus in pediatric patients formerly treated by ventriculoperitoneal (V-P) shunt implantation. From 2001 till 2011, ETV was performed in 42 patients with former V-P drainage implantation. In all patients, the obstruction in aqueduct or outflow parts of the fourth ventricle was proved by MRI. During the surgery, V-P shunt was clipped and ETV was performed. In case of favourable clinical state and MRI functional stoma, the V-P shunt has been removed 3 months after ETV. These patients with V-P shunt possible removing were evaluated as successful. In our group of 42 patients we were successful in 29 patients (69%). There were two serious complications (4.7%)-one patient died 2.5 years and one patient died 1 year after surgery in consequence of delayed ETV failure. ETV is the method of choice in obstructive hydrocephalus even in patients with former V-P shunt implantation. In case of acute or scheduled V-P shunt surgical revision, MRI is feasible, and if ventricular system obstruction is diagnosed, the hydrocephalus may be solved endoscopically.
