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An optimized technique of endoscopic third ventriculocisternostomy (ETV) for children with occlusive hydrocephalus
Albert Akramovich Sufianov1,2, Ekkehard M Kasper3,4, Rinat Albertovich Sufianov5
1Federal State-Financed Institution "Federal Centre of Neurosurgery" of Ministry of Health of the Russian Federation (city of Tyumen), Ul. 4 km. Chervishevskogo trakta, 5, Tyumen, 625032, Russia. sufianov@gmail.com.
Insights
This study introduces a new, minimally invasive endoscopic third ventriculostomy (ETV) technique for pediatric occlusive hydrocephalus. The optimized method offers a safer, more effective surgical option with reduced complications for young patients.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Medical Technology
Background:
- Occlusive hydrocephalus in children presents significant challenges.
- Traditional ETV (Endoscopic Third Ventriculostomy) techniques carry risks, especially in young patients.
Purpose of the Study:
- To present an optimized, minimally invasive ETV technique for pediatric occlusive hydrocephalus.
- To evaluate the safety and efficacy of this modified ETV approach.
Main Methods:
- A modified, minimally invasive ETV technique was applied to 64 pediatric patients (1 month to 5 years) with occlusive hydrocephalus.
- The technique involved reduced soft tissue incision, smaller twist drill holes, and blunt dural trephination for minimal brain damage.
- Continuous endoscopic control was utilized throughout the procedure.
Main Results:
- The optimized ETV technique resulted in a 0% mortality rate and no postoperative neurological, endocrinological, or infectious complications.
- The initial patency rate for ETV was 78%, with some patients requiring further interventions.
- The procedure significantly reduced incision length and brain tissue damage.
Conclusions:
- The minimally invasive ETV technique is a safe and effective treatment for pediatric occlusive hydrocephalus.
- This optimized approach is recommended for broader clinical application in pediatric neurosurgery.
Abstract:
In this article, we present an optimized minimally invasive technique of ETV for children with occlusive hydrocephalus. The study comprises of 64 consecutive pediatric cases (34 boys and 30 girls aged from 1 month to 5 years) of occlusive hydrocephalus from various etiologies, which were treated with a modified technique of ETV. Mean clinical follow-up period after ETV was 24.2 ± 3.8 months. Application of the new technique made it possible to significantly reduce the length of the soft tissue incision for access, and the use of upgraded instruments allowed to perform a twist drill hole in the skull to less than half a usual size. Access to the brain and lateral ventricle was performed by blunt trephination of the dura without the need for significant corticectomy or coagulation, and yielded minimal damage to the brain, which is very important in patients of young age. Continued endoscopic control during the approach down to the lateral ventricle increases safety and decreases risk of injury, and can be performed in cases of pathologies affecting the anatomical relationships of the lateral and third ventricle. Mortality in our cohort was 0%, and there were no postoperative neurological, endocrinological, or infectious complications. Patency rates of the first ETV performed was 78%, with the remaining patients requiring additional surgical procedures for complicated settings. This new technique of minimally invasive ETV placement in pediatric patients is an effective and safe method to treat occlusive hydrocephalus and can be recommended for extensive clinical use.
