Third ventricular shape: a predictor of endoscopic third ventriculostomy success in pediatric patients

Clinical article

Mansoor Foroughi M.B.B.S., F.R.C.S.1, Andrew Wong B.Sc.1, Paul Steinbok M.B.B.S., F.R.C.S.1, Ash Singhal M.D., F.R.C.S.1, Michael A. Sargent M.D., F.R.C.P.C.2, and D. Douglas Cochrane M.D., F.R.C.S.1
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  • 1 Division of Neurosurgery (Department of Surgery) and
  • | 2 Department of Radiology, University of British Columbia and BC Children's Hospital, Vancouver, British Columbia, Canada
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Object

The criteria for identifying patients in whom endoscopic third ventriculostomy (ETV) provides control of hydrocephalus remain in evolution. In particular, it is not clear when ETV would be effective if intraventricular obstruction is not found preoperatively. The authors postulated that 1) displacement of the third ventricle floor inferiorly into the interpeduncular cistern and displacement of the lamina terminalis anteriorly into the lamina terminalis cistern could predict clinical success of ETV, and 2) improvement in these displacements would correlate with the success of ETV.

Methods

Magnetic resonance imaging in 38 consecutive patients treated between 2004 and 2010 was reviewed to assess displacement of the lamina terminalis and third ventricular floor prior to and following ETV. Displacements of the floor and lamina terminalis were judged qualitatively and quantitatively, using a newly created index, the Third Ventricular Morphology Index (TVMI). The association between the aforementioned morphological features and clinical success of ETV was analyzed.

Results

Ninety-six percent of patients in whom the authors preoperatively observed displacement of the lamina terminalis and the third ventricular floor were successfully treated with ETV. Displacements of the third ventricular floor and lamina terminalis, as judged qualitatively, correlated with the clinical success of ETV. The TVMI correlated with the qualitative assessments of displacement. Postoperative decrease in the TVMI occurred in the majority of successfully treated patients. Changes in third ventricular morphology preceded changes in other measures of third and lateral ventricular volume following ETV.

Conclusions

Assessment of third ventricular floor and lamina terminalis morphology is useful in predicting clinical success of ETV and in the follow-up in treated patients. The TVMI provided a quantitative assessment of the third ventricular morphology, which may be useful in equivocal cases and in research studies.

Abbreviations used in this paper:

ETV = endoscopic third ventriculostomy; FOHR; frontal and occipital horn ratio; TVI = Third Ventricle Index; TVMI = Third Ventricular Morphology Index; VP = ventriculoperitoneal.

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  • 1

    Dandy WE: Experimental hydrocephalus. Ann Surg 70:129142, 1919

  • 2

    Dandy WE: An operative procedure for hydrocephalus. Bull Johns Hopkins Hosp 33:189190, 1922

  • 3

    Hailong F, , Guangfu H, , Haibin T, , Hong P, , Yong C, & Weidong L, et al.: Endoscopic third ventriculostomy in the management of communicating hydrocephalus: a preliminary study. Clinical article. J Neurosurg 109:923930, 2008

    • Search Google Scholar
    • Export Citation
  • 4

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

    • Search Google Scholar
    • Export Citation
  • 5

    Hodel J, , Decq P, , Rahmouni A, , Bastuji-Garin S, , Maraval A, & Combes C, et al.: Brain ventricular wall movement assessed by a gated cine MR trueFISP sequence in patients treated with endoscopic third ventriculostomy. Eur Radiol 19:27892797, 2009

    • Search Google Scholar
    • Export Citation
  • 6

    Hopf NJ, , Grunert P, , Fries G, , Resch KD, & Perneczky A: Endoscopic third ventriculostomy: outcome analysis of 100 consecutive procedures. Neurosurgery 44:795806, 1999

    • Search Google Scholar
    • Export Citation
  • 7

    Kehler U, & Gliemroth J: Extraventricular intracisternal obstructive hydrocephalus—a hypothesis to explain successful 3rd ventriculostomy in communicating hydrocephalus. Pediatr Neurosurg 38:98101, 2003

    • Search Google Scholar
    • Export Citation
  • 8

    Kehler U, , Regelsberger J, , Gliemroth J, & Westphal M: Outcome prediction of third ventriculostomy: a proposed hydrocephalus grading system. Minim Invasive Neurosurg 49:238243, 2006

    • Search Google Scholar
    • Export Citation
  • 9

    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
  • 10

    Kulkarni AV, , Drake JM, , Armstrong DC, & Dirks PB: Measurement of ventricular size: reliability of the frontal and occipital horn ratio compared to subjective assessment. Pediatr Neurosurg 31:6570, 1999

    • Search Google Scholar
    • Export Citation
  • 11

    Kulkarni AV, , Drake JM, , Mallucci CL, , Sgouros S, , Roth J, & Constantini S, et al.: Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus. J Pediatr 155:254259, e1, 2009

    • Search Google Scholar
    • Export Citation
  • 12

    Oertel JM, , Mondorf Y, , Schroeder HW, & Gaab MR: Endoscopic diagnosis and treatment of far distal obstructive hydrocephalus. Acta Neurochir (Wien) 152:229240, 2010

    • Search Google Scholar
    • Export Citation
  • 13

    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
  • 14

    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
  • 15

    Schroeder HW, , Niendorf WR, & Gaab MR: Complications of endoscopic third ventriculostomy. J Neurosurg 96:10321040, 2002

  • 16

    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
  • 17

    Warf BC, , Mugamba J, & Kulkarni AV: Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus in Uganda: report of a scoring system that predicts success. Clinical article. J Neurosurg Pediatr 5:143148, 2010

    • Search Google Scholar
    • Export Citation

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