Long-term change in ventricular size following endoscopic third ventriculostomy for hydrocephalus due to tectal plate gliomas

Clinical article

Andrew Romeo M.D. 1 , Robert P. Naftel M.D. 1 , Christoph J. Griessenauer M.D. 1 , Gavin T. Reed M.P.H. 1 , Richard Martin M.D. 2 , Chevis N. Shannon Dr. P.H., M.B.A. 1 , Paul A. Grabb M.D. 3 , R. Shane Tubbs M.S., P.A.-C., Ph.D. 1 , and John C. Wellons III M.D., M.S.P.H. 4
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  • 1 Section of Pediatric Neurosurgery, Division of Neurosurgery, University of Alabama, Children's Hospital;
  • 2 Department of Pediatric Radiology, Children's Hospital, Birmingham, Alabama;
  • 3 Colorado Springs Children's Hospital, Colorado Springs, Colorado; and
  • 4 Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Object

Endoscopic third ventriculostomy (ETV) is an alternative to shunt placement in children with hydrocephalus due to tectal plate gliomas (TPGs). However, controversy remains regarding the amount of ventricular size reduction that should be expected after ETV. This study investigates ventricular size change after ETV for TPGs.

Methods

Twenty-two children were identified from a 15-year retrospective database of neuroendoscopic procedures performed at the authors' institution, Children's Hospital of Alabama, in patients with a minimum of 1 year of follow-up. Clinical outcomes, including the need for further CSF diversion and symptom resolution, were recorded. The frontal and occipital horn ratio (FOR) was measured on pre- and postoperative, 1-year, and last follow-up imaging studies.

Results

In 17 (77%) of 22 children no additional procedure for CSF diversion was required. Of those in whom CSF diversion failed, 4 underwent successful repeat ETV and 1 required shunt replacement. Therefore, in 21 (96%) of 22 patients, CSF diversion was accomplished with ETV. Preoperative and postoperative imaging was available for 18 (82%) of 22 patients. The FOR decreased in 89% of children who underwent ETV. The FOR progressively decreased 1.7%, 11.2%, and 12.7% on the initial postoperative, 1-year, and last follow-up images, respectively. The mean radiological follow-up duration for 18 patients was 5.4 years. When ETV failed, the FOR increased at the time of failure in all patients. Failure occurred 1.6 years after initial ETV on average. The mean clinical follow-up period for all 22 patients was 5.3 years. In all cases clinical improvement was demonstrated at the last follow-up.

Conclusions

Endoscopic third ventriculostomy successfully treated hydrocephalus in the extended follow-up period of patients with TPGs. The most significant reduction in ventricular size was observed at the the 1-year followup, with only modest reduction thereafter.

Abbreviations used in this paper:ETV = endoscopic third ventriculostomy; FOR = frontal and occipital horn ratio; ICP = intracranial pressure; TPG = tectal plate glioma; VP = ventriculoperitoneal.

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Contributor Notes

Address correspondence to: John C. Wellons III, M.D., Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee 37232. email: John.Wellons@vanderbilt.edu.

Please include this information when citing this paper: published online November 9, 2012; DOI: 10.3171/2012.9.PEDS12243.

  • 1

    Bargalló N, , Olondo L, , Garcia AI, , Capurro S, , Caral L, & Rumia J: Functional analysis of third ventriculostomy patency by quantification of CSF stroke volume by using cine phase-contrast MR imaging. AJNR Am J Neuroradiol 26:25142521, 2005

    • Search Google Scholar
    • Export Citation
  • 2

    Bognar L, , Turjman F, , Villanyi E, , Mottolese C, , Guyotat J, & Fischer C, : Tectal plate gliomas. Part II: CT scans and MR imaging of tectal gliomas. Acta Neurochir (Wien) 127:4854, 1994

    • Search Google Scholar
    • Export Citation
  • 3

    Bowers DC, , Georgiades C, , Aronson LJ, , Carson BS, , Weingart JD, & Wharam MD, : Tectal gliomas: natural history of an indolent lesion in pediatric patients. Pediatr Neurosurg 32:2429, 2000

    • Search Google Scholar
    • Export Citation
  • 4

    Buxton N, , Turner B, , Ramli N, & Vloeberghs M: Changes in third ventricular size with neuroendoscopic third ventriculostomy: a blinded study. J Neurol Neurosurg Psychiatry 72:385387, 2002

    • Search Google Scholar
    • Export Citation
  • 5

    Chapman PH, Indolent gliomas of the midbrain tectum. Martin AE: Concepts in Pediatric Neurosurgery Basel, Switzerland, Karger, 1989. 97107

    • Search Google Scholar
    • Export Citation
  • 6

    Dağlioğlu E, , Cataltepe O, & Akalan N: Tectal gliomas in children: the implications for natural history and management strategy. Pediatr Neurosurg 38:223231, 2003

    • Search Google Scholar
    • Export Citation
  • 7

    Goumnerova LC, & Frim DM: Treatment of hydrocephalus with third ventriculocisternostomy: outcome and CSF flow patterns. Pediatr Neurosurg 27:149152, 1997

    • Search Google Scholar
    • Export Citation
  • 8

    Grant GA, , Avellino AM, , Loeser JD, , Ellenbogen RG, , Berger MS, & Roberts TS: Management of intrinsic gliomas of the tectal plate in children. A ten-year review. Pediatr Neurosurg 31:170176, 1999

    • Search Google Scholar
    • Export Citation
  • 9

    Hellwig D, , Grotenhuis JA, , Tirakotai W, , Riegel T, , Schulte DM, & Bauer BL, : Endoscopic third ventriculostomy for obstructive hydrocephalus. Neurosurg Rev 28:138, 2005

    • Search Google Scholar
    • Export Citation
  • 10

    Javadpour M, & Mallucci C: The role of neuroendoscopy in the management of tectal gliomas. Childs Nerv Syst 20:852857, 2004

  • 11

    Konno H, , Yamamoto T, , Iwasaki Y, , Iinuma K, & Takahashi Y: A case of quadrigeminal hamartoma. Acta Neuropathol 68:155159, 1985

  • 12

    Kulkarni AV, , Drake JM, , Armstrong DC, & Dirks PB: Imaging correlates of successful endoscopic third ventriculostomy. J Neurosurg 92:915919, 2000

    • Search Google Scholar
    • Export Citation
  • 13

    Kulkarni AV, , Drake JM, , Mallucci CL, , Sgouros S, , Roth J, & Constantini S: Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus. J Pediatr 155:254259, 2009

    • Search Google Scholar
    • Export Citation
  • 14

    Lapras C, , Bognar L, , Turjman F, , Villanyi E, , Mottolese C, & Fischer C, : Tectal plate gliomas. Part I: Microsurgery of the tectal plate gliomas. Acta Neurochir (Wien) 126:7683, 1994

    • Search Google Scholar
    • Export Citation
  • 15

    Lázaro BC, & Landeiro JA: Tectal plate tumors. Arq Neuropsiquiatr 64:432436, 2006

  • 16

    Li KW, , Roonprapunt C, , Lawson HC, , Abbott IR, , Wisoff J, & Epstein F, : Endoscopic third ventriculostomy for hydrocephalus associated with tectal gliomas. Neurosurg Focus 18:6A E2, 2005

    • Search Google Scholar
    • Export Citation
  • 17

    May PL, , Blaser SI, , Hoffman HJ, , Humphreys RP, & Harwood-Nash DC: Benign intrinsic tectal “tumors” in children. J Neurosurg 74:867871, 1991

    • Search Google Scholar
    • Export Citation
  • 18

    O'Hayon BB, , Drake JM, , Ossip MG, , Tuli S, & Clarke M: Frontal and occipital horn ratio: A linear estimate of ventricular size for multiple imaging modalities in pediatric hydrocephalus. Pediatr Neurosurg 29:245249, 1998

    • Search Google Scholar
    • Export Citation
  • 19

    Pendl G, , Vorkapic P, & Koniyama M: Microsurgery of midbrain lesions. Neurosurgery 26:641648, 1990

  • 20

    Poussaint TY, , Kowal JR, , Barnes PD, , Zurakowski D, , Anthony DC, & Goumnerova L, : Tectal tumors of childhood: clinical and imaging follow-up. AJNR Am J Neuroradiol 19:977983, 1998

    • Search Google Scholar
    • Export Citation
  • 21

    Ramina R, , Coelho Neto M, , Fernandes YB, , Borges G, , Honorato DC, & Arruda WO: Intrinsic tectal low grade astrocytomas: is surgical removal an alternative treatment? Long-term outcome of eight cases. Arq Neuropsiquiatr 63:4045, 2005

    • Search Google Scholar
    • Export Citation
  • 22

    Sacko O, , Boetto S, , Lauwers-Cances V, , Dupuy M, & Roux FE: Endoscopic third ventriculostomy: outcome analysis in 368 procedures. Clinical article. J Neurosurg Pediatr 5:6874, 2010

    • Search Google Scholar
    • Export Citation
  • 23

    Sanford RA, , Bebin J, & Smith RW: Pencil gliomas of the aqueduct of Sylvius. Report of two cases. J Neurosurg 57:690696, 1982

  • 24

    Santamarta D, , Martin-Vallejo J, , Díaz-Alvarez A, & Maillo A: Changes in ventricular size after endoscopic third ventriculostomy. Acta Neurochir (Wien) 150:119127, 2008

    • Search Google Scholar
    • Export Citation
  • 25

    Schwartz TH, , Ho B, , Prestigiacomo CJ, , Bruce JN, , Feldstein NA, & Goodman RR: Ventricular volume following third ventriculostomy. J Neurosurg 91:2025, 1999

    • Search Google Scholar
    • Export Citation
  • 26

    St George E, , Natarajan K, & Sgouros S: Changes in ventricular volume in hydrocephalic children following successful endoscopic third ventriculostomy. Childs Nerv Syst 20:834838, 2004

    • Search Google Scholar
    • Export Citation
  • 27

    Stark AM, , Fritsch MJ, , Claviez A, , Dörner L, & Mehdorn HM: Management of tectal glioma in childhood. Pediatr Neurol 33:3338, 2005

  • 28

    Ternier J, , Wray A, , Puget S, , Bodaert N, , Zerah M, & Sainte-Rose C: Tectal plate lesions in children. J Neurosurg 104:6 Suppl 369376, 2006

  • 29

    Wellons JC III, , Tubbs RS, , Banks JT, , Grabb B, , Blount JP, & Oakes WJ, : Long-term control of hydrocephalus via endoscopic third ventriculostomy in children with tectal plate gliomas. Neurosurgery 51:6368, 2002

    • Search Google Scholar
    • Export Citation
  • 30

    Yeh DD, , Warnick RE, & Ernst RJ: Management strategy for adult patients with dorsal midbrain gliomas. Neurosurgery 50:735740, 2002

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