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Endoscopic third ventriculostomy in obstructive hydrocephalus due to giant basilar artery aneurysm

Report of 3 cases

Joachim M. K. Oertel, Yvonne Mondorf, and Michael R. Gaab

the aneurysm 3 months later. After the intervention, the patient experienced progressive BA thrombosis and subsequently died within the 1st week after intervention. Discussion Endoscopic third ventriculostomy represents the gold standard for the treatment of obstructive hydrocephalus. The complication rate of ETV is rather low, 29 , 32 and fatal complications are rare compared with other neurosurgical procedures. Vascular complications are the most feared ones and range from cerebral infarction 7 to induction of false aneurysm development 1 , 15 , 21 and

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Late obstruction of an endoscopic third ventriculostomy stoma by metastatic seeding of a recurrent medulloblastoma

Case report

Flávio Nigri, Carlos Telles, and Marcus André Acioly

E ndoscopic third ventriculostomy has been established as an effective method in the treatment of tumoral obstructive hydrocephalus. 14 , 18 Delayed closure of the ETV stoma has been attributed to scarring involving the third ventricular floor, 5 , 8 , 12 which is occasionally associated with rapid deterioration and fatal outcome. 5 , 8 We report on a unique case of late closure of the ETV stoma caused by metastatic seeding of a recurrent medulloblastoma 9 years after the initial treatment. Case Report History and Examination This 18-year

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Emergency endoscopic third ventriculostomy for blocked shunts? Univariate and multivariate analysis of independent predictors for failure

David Y. C. Chan, Anderson C. O. Tsang, Wilson W. S. Ho, Kevin K. F. Cheng, Lai F. Li, Frederick C. P. Tsang, Benedict B. T. Taw, Jenny K. S. Pu, Gilberto K. K. Leung, and Matthew W. M. Lui

H ydrocephalus with a blocked ventriculoperitoneal (VP) shunt is a life-threatening condition. Treatment options include shunt revision or externalization of the shunt. Pitfalls include risks of further shunt failure from either a blocked shunt or shunt infection. An alternative treatment is emergency endoscopic third ventriculostomy (ETV). The ETV success score (ETVSS) has been shown to have good predictive value in the treatment’s success rate. 15 , 17 However, an external validation study has shown that the predictive value of ETVSS for secondary ETV is not

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Fatal subarachnoid hemorrhage after endoscopic third ventriculostomy

Case report

Henry W. S. Schroeder, Rolf W. Warzok, Jamal A. Assaf, and Michael R. Gaab

In recent years, endoscopic third ventriculostomy has become a well-established procedure for the treatment of various forms of noncommunicating hydrocephalus. Endoscopic third ventriculostomy is considered to be an easy and safe procedure. Complications have rarely been reported in the literature. The authors present a case in which the patient suffered a fatal subarachnoid hemorrhage (SAH) after endoscopic third ventriculostomy.

This 63-year-old man presented with confusion and drowsiness and was admitted in to the hospital in poor general condition. Computerized tomography scanning revealed an obstructive hydrocephalus caused by a tumor located in the cerebellopontine angle. An endoscopic third ventriculostomy was performed with the aid of a Fogarty balloon catheter. Some hours postoperatively, the patient became comatose. Computerized tomography scanning revealed a severe perimesencephalic-peripontine SAH and progressive hydrocephalus. Despite emergency external ventricular drainage, the patient died a few hours later.

Although endoscopic third ventriculostomy is considered to be a simple and safe procedure, one should be aware that severe and sometimes fatal complications may occur. To avoid vascular injury, perforation of the floor of the third ventricle should be performed in the midline, halfway between the infundibular recess and the mamillary bodies, just behind the dorsum sellae.

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Endoscopic third ventriculostomy in patients with cerebrospinal fluid infection and/or hemorrhage

Vitaly Siomin, Giuseppe Cinalli, Andre Grotenhuis, Aprajay Golash, Shizuo Oi, Karl Kothbauer, Howard Weiner, Jonathan Roth, Liana Beni-Adani, Alain Pierre-Kahn, Yasuhiro Takahashi, Connor Mallucci, Rick Abbott, Jeffrey Wisoff, and Shlomi Constantini

E ndoscopic third ventriculostomy practiced as an alternative to shunting procedures has revolutionized the management of hydrocephalus. Today, ETV is the procedure of choice for patients with obstructive hydrocephalus caused by aqueductal stenosis, with the success rate reaching 60 to 85% in most reported series. 3, 7, 13, 15, 16 Patients, however, with a history of CSF infection (for example, meningitis, ventriculitis, or shunt infection) or IVH or subarachnoid hemorrhage have not been included in ETV studies in significant numbers. Instead, such patients

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Late rapid deterioration after endoscopic third ventriculostomy: additional cases and review of the literature

James Drake, Paul Chumas, John Kestle, Alain Pierre-Kahn, Matthieu Vinchon, Jennifer Brown, Ian F. Pollack, and Hajime Arai

E ndoscopic third ventriculostomy has been used increasingly to treat hydrocephalus associated with obstructive hydrocephalus, both de novo and in patients who have indwelling shunts and who usually present with a shunt obstruction. 3 , 5 , 15 , 23 Recently, the application of the procedure has been expanded to patients with hydrocephalus associated with fourth ventricular outlet obstruction, Dandy–Walker malformation, 19 Chiari malformation, 2 , 6 , 17 , 21 and communicating hydrocephalus, including normal-pressure hydrocephalus. 9 , 16 Although

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Postoperative seizures following endoscopic third ventriculostomy and choroid plexus cauterization: a case series

Randaline R. Barnett, Allie L. Harbert, Hengameh B. Pajer, Angela Wabulya, Valerie L. Jewells, Scott W. Elton, and Carolyn S. Quinsey

T reatment of hydrocephalus in children younger than 2 years of age can involve endoscopic third ventriculostomy and choroid plexus cauterization (ETV/CPC). The safety and effectiveness of ETV/CPC in treating hydrocephalus in children have been studied in sub-Saharan Africa and North America. These studies have demonstrated that ETV/CPC can be used as an alternative to ventriculoperitoneal shunting or ETV alone. 1–5 In a study of children younger than 1 year of age, the success rate of ETV/CPC was 66% compared with 47% in those treated with ETV alone. 6

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Preoperative third ventricular bowing as a predictor of endoscopic third ventriculostomy success

Clinical article

Brian J. Dlouhy, Ana W. Capuano, Karthik Madhavan, James C. Torner, and Jeremy D. W. Greenlee

treatment. 36 However, many patients may have both components of hydrocephalus. 43 Prior to the wide use of ETV, these descriptions were mostly academic, because CSF was simply shunted to areas outside the brain for absorption. With ETV, there is a reliance on CSF absorption within the neuraxis, and therefore hydrocephalus classification becomes much more important for surgeons and their preoperative counseling of patients and patients' families in deciding whether to perform an ETV or a shunt insertion. It is classically thought that a third ventriculostomy would only

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Long-term follow-up of endoscopic third ventriculostomy performed in the pediatric population

Matthew G. Stovell, Rasheed Zakaria, Jonathan R. Ellenbogen, Mathew J. Gallagher, Michael D. Jenkinson, Caroline Hayhurst, and Conor L. Mallucci

O ver the last few decades, endoscopic third ventriculostomy (ETV) has become a common treatment for pediatric hydrocephalus. This development is due to improved safety of the procedure enabled through advances in MRI and endoscopic technology. Endoscopic third ventriculostomy has a high rate of early failure, which is influenced largely by the indications used for the procedure and also by the technical abilities and experience of the surgeon. Many studies have reported short-term success (≤ 6 months) and intermediate-term success (≤ 3 years) of ETV

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Resolution of papilledema after endoscopic third ventriculostomy versus cerebrospinal fluid shunting in hydrocephalus: a comparative study

Clinical article

Ender Koktekir, Bengu Ekinci Koktekir, Hakan Karabagli, Sansal Gedik, and Gokhan Akdemir

H ydrocephalus is the clinical condition characterized by enlargement of cerebral ventricles and associated symptoms caused by raised intracranial pressure (ICP). The main goal of treatment is to decrease raised ICP, either by CSF shunt treatment or endoscopic third ventriculostomy (ETV). 6 , 9 Recently, due to higher morbidity rates and the issue of “shunt dependency” with CSF shunting, ETV has been highly recommended in appropriate cases. 5 , 6 However, concern remains about the efficacy of ETV in decreasing raised ICP. The literature has rarely