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Extra-axial endoscopic third ventriculostomy: preliminary experience with a technique to circumvent conventional endoscopic third ventriculostomy complications

Sanjeev Kumar, Debabrata Sahana, Lavlesh Rathore, Amit Jain, Manish Tawari, Deepak Singh, Rajiv Sahu, and Satya Narayan Madhariya

E ndoscopic third ventriculostomy (ETV) is the most common physiological treatment for hydrocephalus. Although safe in expert hands, ETV may have infrequent but dreaded complications. The overall complication rate varies from 2% to 15%. 1 – 4 The lamina terminalis is a semitransparent membrane forming the anterior wall of the third ventricle. A success rate of nearly 70% after transventricular lamina terminalis fenestration using a flexible and rigid endoscope has been reported. 5 Many procedural complications of conventional ETV can be avoided by using

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Predictors of endoscopic third ventriculostomy ostomy status in patients who experience failure of endoscopic third ventriculostomy with choroid plexus cauterization

Andrew T. Hale, Amanda N. Stanton, Shilin Zhao, Faizal Haji, Stephen R. Gannon, Anastasia Arynchyna, John C. Wellons, Brandon G. Rocque, and Robert P. Naftel

E ndoscopic third ventriculostomy (ETV) with choroid plexus cauterization (CPC) has rapidly increased in use since its inception. 4 , 24 Many studies have investigated the effectiveness of ETV/CPC versus ventriculoperitoneal shunt (VP) placement, 13 , 14 , 25 including differentiating clinical and radiographic features defining ETV/CPC from VP shunt success. 2 While both procedures are effective in reducing intracranial pressure by diverting CSF, ETV/CPC success promises shunt independence and may be associated with decreased overall healthcare costs. 15

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Multiple echocardiography abnormalities associated with endoscopic third ventriculostomy failure

Ashish H. Shah, George M. Ibrahim, Jun Sasaki, John Ragheb, Sanjiv Bhatia, and Toba N. Niazi

P rogressive hydrocephalus in infants often requires surgical intervention that frequently involves ventriculoperitoneal shunting. In an effort to reduce the need for a ventriculoperitoneal shunt (VPS) and potentially limit exposure to its associated complications in this population, endoscopic third ventriculostomy and choroid plexus cauterization (ETV/CPC) have been offered as a viable alternative to treat both obstructive and communicating hydrocephalus. 9 , 10 , 21 Success rates of 40%–60% in controlling hydrocephalus 1 year after ETV/CPC in developed

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Editorial: Endoscopic third ventriculostomy

James Drake

This paper is a further report on the remarkable and unique group of patients with hydrocephalus treated by Dr. Warf and his colleagues at the CURE Children's Hospital of Uganda from 2000 to 2007. 1 , 3 , 4 In this analysis the authors focus on 900 patients of the 2329-patient cohort who had a VP shunt, in terms of the possible role of prior endoscopic third ventriculostomy (ETV) and/or choroid plexus coagulation (CPC) in subsequent shunt failure. This is an important question in the minds of all pediatric neurosurgeons: Are there other procedures, or

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Low-cost endoscopic third ventriculostomy simulator with mimetic endoscope

Richard Justin Garling, Xin Jin, Jianzhong Yang, Ahmad H. Khasawneh, and Carolyn Anne Harris

H ydrocephalus , a condition caused by excess production or decreased absorption of CSF, affects approximately 1 in 500 people in the US. 19 This imbalance of CSF absorption/production can lead to increased ventricular size and compression of vital brain structures. 13 Ventricular shunting, the gold standard of treatment, has a nearly 85% failure rate. 9 Endoscopic third ventriculostomy (ETV) is an alternative surgical approach to ventricular shunting but is limited to a specific subset of hydrocephalic patients whose hydrocephalus is due to aqueductal

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Robot-assisted endoscopic third ventriculostomy: institutional experience in 9 patients

Reid Hoshide, Mark Calayag, Hal Meltzer, Michael L. Levy, and David Gonda

T he endoscopic third ventriculostomy (ETV) was first performed by Mixter in 1923; he used urological instruments as the means for visualization and perforation of the third ventricular floor. Since then, this procedure has been refined to include choroid plexus coagulation, stereotaxy, and flexible endoscopes. 6 This has been an attractive procedure when contrasted to CSF shunting, which requires implantable hardware. The failure and infection rates of indwelling shunts have been an issue to the patients, their families, and surgeons alike. The probability of

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Stereotactic third ventriculostomy in patients with nontumoral adolescent/adult onset aqueductal stenosis and symptomatic hydrocephalus

Patrick J. Kelly

T he subarachnoid space and cerebrospinal fluid (CSF) absorption mechanisms are usually intact in patients with acquired hydrocephalus. 8, 9 For this reason, methods of “internal shunting” such as third ventriculostomy by open craniotomy 6, 7, 15, 43 or percutaneous techniques, 16, 18, 27, 28, 34, 38 aqueductal reconstruction, 3, 5, 25 and Torkildsen's ventriculocisternostomy 45 have been employed to treat obstructive hydrocephalus. Because of unacceptable rates of operative morbidity and mortality and inconsistent results in the control of hydrocephalus

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Evaluating the Children's Hospital of Alabama endoscopic third ventriculostomy experience using the Endoscopic Third Ventriculostomy Success Score: an external validation study

Clinical article

Robert P. Naftel, Gavin T. Reed, Abhaya V. Kulkarni, and John C. Wellons III

E ndoscopic third ventriculostomy is an alternative to CSF shunt therapy in patients with hydrocephalus. 9 In selected patients, there are long-term benefits to ETV compared with shunt insertion. 19 , 20 While ETV-related complications are infrequent, those that occur can lead to significant deficits or even death. 1 , 7 , 35 , 36 Therefore, a preoperative scoring scale to predict ETV success could assist with identifying patients who are likely to respond well to ETV and allow the surgeon to counsel families regarding treatment options. The success

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Third Ventriculostomy in Obstructive Hydrocephalus

Long-Term Arrest of Hydrocephalus in 4 Cases

James S. Volkel and Harold C. Voris

by itself is an inadequate means of evaluation. Ventricles may gradually enlarge with corresponding damage to the so-called cerebral mantle even though the head size is not increasing (patient P.B.). In other words, the brain is more susceptible to chronic low grade increased intracranial pressure than is the fontanelle membrane and cranial suture lines. None of the patients that have had 3rd ventriculostomy have shown the dramatic depression of the fontanelle and decrease in head circumference that follows successful shunt operations. Third ventriculostomy by

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Hydrocephalus in mucopolysaccharidosis Type VI successfully treated with endoscopic third ventriculostomy

Case report

Ângelo Raimundo da Silva Neto, Gervina Brady Moreira Holanda, Maria Cláudia Saldanha Farias, Gladstone Santos da Costa, and Hougelle Simplício Gomes Pereira

associated with spinal cord compression close to the foramen magnum ( Fig. 1 ). Given the refractoriness of symptoms to conservative treatment and the hydrocephalus, we opted for surgery. F ig . 1. Sagittal T2-weighted MR image showing obstruction of the outlets from the fourth ventricle and hydrocephalus in association with cord compression at the craniocervical transition. Operation A third ventriculostomy was performed using a Fogarty 4-Fr catheter through a minor right frontal bur hole. The procedure was conducted with the patient under general