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Repeat endoscopic third ventriculostomy success rate according to ventriculostoma closure patterns in children
Volkan Etus1, Gokmen Kahilogullari2, Aykut Gokbel3
1Department of Neurosurgery, Kocaeli University, Kocaeli, Turkey.
Insights
Repeat endoscopic third ventriculostomy (redo-ETV) success varies by closure type in pediatric hydrocephalus. Type 2 closure showed the highest success rate for redo-ETV, offering insights for surgical planning.
Area of Science:
- Neurosurgery
- Pediatric Neurosurgery
- Hydrocephalus Management
Background:
- Endoscopic third ventriculostomy (ETV) is a primary treatment for hydrocephalus.
- Ventriculostoma closure can necessitate repeat procedures (redo-ETV).
- Understanding closure patterns is crucial for optimizing redo-ETV outcomes.
Purpose of the Study:
- To evaluate the success rate of repeat endoscopic third ventriculostomy (redo-ETV).
- To correlate redo-ETV success with specific patterns of ventriculostoma closure.
- To analyze outcomes in 97 pediatric patients undergoing redo-ETV.
Main Methods:
- Retrospective analysis of clinical data and intraoperative videos from 97 pediatric redo-ETV patients.
- Exclusion of patients with prior intraventricular hemorrhage, CSF infection, or shunt surgery.
- Classification of ventriculostoma closure into three types using MRI: Type 1 (total closure), Type 2 (membrane narrowing), Type 3 (patent orifice with blockage).
Main Results:
- Overall redo-ETV success rate was 37.1%.
- Success rates varied by closure type: Type 1 (25%), Type 2 (43.6%), Type 3 (38.2%).
- Type 1 closure was more frequent in myelomeningocele-related hydrocephalus.
Conclusions:
- Reopening the stoma (redo-ETV) is feasible for ventriculostoma closure.
- Success rates of redo-ETV differ significantly based on the pattern of ventriculostoma closure.
- Further studies are needed to validate these preliminary findings on closure types and redo-ETV success rates.
Purpose:
This study aimed to examine the success rate of repeat endoscopic third ventriculostomy (redo-ETV) according to pattern of ventriculostoma closure based on observations in 97 paediatric redo-ETV patients.
Methods:
Clinical data and intraoperative video recordings of 97 paediatric hydrocephalus patients who underwent redo-ETV due to ventriculostoma closure at two institutions were retrospectively analysed. We excluded patients with a history of intraventricular haemorrhage, cerebrospinal fluid (CSF) infection or CSF shunt surgery and those with incompletely penetrated membranes during the initial ETV.
Results:
Verification of ventriculostoma closure was confirmed with cine phase-contrast magnetic resonance imaging and classified into 3 types: type 1, total closure of the ventriculostoma by gliosis or scar tissue that results in a non-translucent/opaque third ventricle floor; type 2, narrowing/closure of the ventriculostoma by newly formed translucent/semi-transparent membranes; and type 3, presence of a patent ventriculostoma orifice with CSF flow blockage by newly formed reactive membranes or arachnoidal webs in the basal cisterns. The overall success rate of redo-ETV was 37.1%. The success rates of redo-ETV according to closure type were 25% for type 1, 43.6% for type 2 and 38.2% for type 3. The frequency of type 1 ventriculostoma closure was significantly higher in patients with myelomeningocele-related hydrocephalus.
Conclusion:
For patients with ventriculostoma closure after ETV, reopening of the stoma can be performed. Our findings regarding the frequencies of ventriculostoma closure types and the success rate of redo-ETV in paediatric patients according to ventriculostoma closure type are preliminary and should be verified by future studies.
