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Long-term results of endoscopic third ventriculostomy: an outcome analysis

Sonja Vulcu, Leonie Eickele, Giuseppe Cinalli, Wolfgang Wagner, and Joachim Oertel

T he technique of endoscopic third ventriculostomy (ETV) has been under close evaluation as a treatment option for obstructive hydrocephalus. Although early on the procedure was associated with a very high, unacceptable complication rate, 41 more recent publications have reported success rates of about 70% and low complication rates, including mortality, around 0.5%–1.0%. 9 , 13 , 20 , 31 , 35 Nowadays, ETV is accepted as the gold standard for treatment of obstructive hydrocephalus. In comparison with ventriculoperitoneal shunting, a significantly lower

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Endoscopic third ventriculostomy for pediatric tumor-associated hydrocephalus

Brandon A. Sherrod, Rajiv R. Iyer, and John R. W. Kestle

management alone are ineffective. Endoscopic third ventriculostomy (ETV) was initially described in 1923 by William Mixter 25 as a treatment strategy for hydrocephalus and has appeal as a method to reduce the risk of introducing hardware-related infectious complications in children who need surgical treatment for hydrocephalus. Numerous studies have compared ETV and VPS in regard to efficacy and infection rates in treatment of pediatric hydrocephalus in general, with the consensus being that ETV reduces procedural infection risk, but the overall reoperation rates for

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Use of the NeuroBalloon catheter for endoscopic third ventriculostomy

Technical note

Raphael Guzman, Arjun V. Pendharkar, Michel Zerah, and Christian Sainte-Rose

E ndoscopic third ventriculostomy is a commonly used procedure for obstructive hydrocephalus 5 , 8 , 13 due to primary aqueductal stenosis or intraventricular, 17 pineal, tectal, 14 or posterior fossa tumors. 2 , 11 , 19 The goal of the procedure is to create an alternate path for CSF circulation and resorption through an artificial fenestration in the floor of the third ventricle. In contrast to a ventriculoperitoneal shunt, ETVs mimic intracranial physiological CSF circulation and avoid the risk of mechanical obstruction and infection associated with

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Endoscopic third ventriculostomy in previously shunt-treated patients

Brandon G. Rocque, Hailey Jensen, Ron W. Reeder, Abhaya V. Kulkarni, Ian F. Pollack, John C. Wellons III, Robert P. Naftel, Eric M. Jackson, William E. Whitehead, Jonathan A. Pindrik, David D. Limbrick Jr., Patrick J. McDonald, Mandeep S. Tamber, Todd C. Hankinson, Jason S. Hauptman, Mark D. Krieger, Jason Chu, Tamara D. Simon, Jay Riva-Cambrin, John R. W. Kestle, Curtis J. Rozzelle, and for the Hydrocephalus Clinical Research Network

C erebrospinal fluid shunting remains the most common treatment for pediatric hydrocephalus. Endoscopic third ventriculostomy (ETV) is an alternative to CSF shunting that is potentially favorable due to the lack of implanted hardware. Most previous studies of ETV have focused on its role as an initial treatment for hydrocephalus and on comparing ETV to CSF shunting. However, there are some children who have previously been treated with a CSF shunt who may be candidates for ETV. This clinical scenario—ETV performed in children with a history of CSF shunting

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Endoscopic third ventriculostomy

Taopheeq Bamidele Rabiu

T o T he E ditor : The work by Greenfield and colleagues 3 (Greenfield JP, Hoffman C, Kuo E, et al: Intraoperative assessment of endoscopic third ventriculostomy success. Clinical article. J Neurosurg Pediatr 2: 298–303, November, 2008) represents an important contribution to our understanding of the pathophysiology of endoscopic third ventriculostomy (ETV) outcome and a significant move toward the creation of an acceptable guideline for the endoscopic management of hydrocephalus. The use of ETV in infants is the subject of an ongoing debate. Some

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Endoscopic third ventriculostomy in patients with a diminished prepontine interval

Clinical article

Mark M. Souweidane, Peter F. Morgenstern, Sungkwon Kang, Apostolos John Tsiouris, and Jonathan Roth

E ndoscopic third ventriculostomy is a preferred treatment in most patients with noncommunicating hydrocephalus. The endoscopic technique and associated morbidity have been thoroughly described. In fact, the incidence of permanent morbidity and mortality has been reported to be as low as 0%. 9 , 18 However, the most significant complication of ETV is inadvertent injury to the BA or other tributaries to the posterior circle of Willis. 1 , 10 , 14 , 19 , 21 Thus, the dimensions of the prepontine subarachnoid space, or PPI, has been implicated as an important

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Hydrocephalus in achondroplasia: efficacy of endoscopic third ventriculostomy

Jun Kim, Vishal J. Patel, Tarek Y. El Ahmadieh, DaiWai M. Olson, and Dale M. Swift

endoscopic third ventriculostomy (ETV). 6 In the current study, we report the long-term outcomes of those patients and describe 9 additional patients with achondroplasia-associated hydrocephalus in whom ETV was deemed successful. We also compare the rates of reoperation following ETV with patients treated with ventriculoperitoneal shunts (VPSs) and discuss possible mechanisms for the development of “obstructive” hydrocephalus in patients with achondroplasia. Methods IRB approval was obtained and the prospectively maintained achondroplasia database at the

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Comparative analysis of endoscopic third ventriculostomy trajectories in pediatric cases

Zsolt Zador, David J. Coope, and Ian D. Kamaly-Asl

E ndoscopic third ventriculostomy (ETV) has emerged as an alternative method of CSF diversion alongside the placement of ventriculoperitoneal shunts. 18–20 ETV has been primarily advocated as an aqueductal bypass procedure for obstructive hydrocephalus, 12 but its application has now expanded to treating hydrocephalus of nonobstructive etiologies 1 , 5 , 8 with an overall success rate ranging from 68.5% to 83% in large mixed series. 1 , 2 , 13 , 23 Parallel to these high success rates, a recent review demonstrates an overall complication rate of 8

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Pediatric endoscopic third ventriculostomy: a population-based study

Clinical article

Sandi Lam, Dominic Harris, Brandon G. Rocque, and Sandra A. Ham

T he prevalence of congenital/infantile hydrocephalus in the US and Europe has been estimated to range from 0.5 to 0.8 per 1000 live births. 5–7 , 16 Hydrocephalus represents a high health care burden in the US, with ventriculoperitoneal (VP) shunting and its associated hospital charges totaling almost $2 billion annually in children 0–18 years. 18 The burden of hydrocephalus is reported to be even higher in developing nations. 23 Potential treatments for hydrocephalus include CSF diversion with VP shunt placement and endoscopic third ventriculostomy

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Endoscopic third ventriculostomy in hydrocephalus associated with achondroplasia

Report of 3 cases

Dale Swift, Laszlo Nagy, and Brian Robertson

an opening pressure of 20 cm H 2 O, indicating abnormally high resistance either in the valve or distal catheter. Endoscopic third ventriculostomy was considered given the distended appearance of the third ventricle ( Fig. 2C ). Retrograde venography demonstrated a 6-mm Hg pressure gradient across the jugular foramen. Operation An ETV was performed when the patient was 33 months of age, and the VP shunt was left in place. Postoperative Course Post-ETV MR imaging demonstrated a decrease in ventricular size ( Figs. 2D and 4B ), and repeat shunt