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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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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

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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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Cognitive and gait outcomes after primary endoscopic third ventriculostomy in adults with chronic obstructive hydrocephalus

Thomas J. Zwimpfer, Nicholas Salterio, Michael A. Williams, Richard Holubkov, Heather Katzen, Mark G. Luciano, Abhay Moghekar, Sean J. Nagel, Jeffrey H. Wisoff, James Golomb, Guy M. McKhann, Richard J. Edwards, Mark G. Hamilton, and for the Adult Hydrocephalus Clinical Research Network

A dults with obstructive hydrocephalus can present with either acute symptoms associated with raised intracranial pressure (ICP) or more gradual and chronic symptoms, including impairment of cognition, gait, or urinary control. 1 , 2 Endoscopic third ventriculostomy (ETV) is effective at relieving symptoms of increased ICP in adult obstructive hydrocephalus. 3 , 4 The reported success rate for primary ETV in adults with untreated obstructive hydrocephalus, defined as not needing a subsequent shunt or repeat ETV, ranges from 73% to 87%. 3 , 4 ETV may

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Anterior third ventricular height and infundibulochiasmatic angle: two novel measurements to predict clinical success of endoscopic third ventriculostomy in the early postoperative period

Mehmet Sabri Gürbüz, Adnan Dağçınar, Yaşar Bayri, Aşkın Şeker, and Hasan Güçlü

E ndoscopic third ventriculostomy (ETV) is the procedure of choice for patients with obstructive hydrocephalus. 3 , 13 , 22 , 29 , 31 An ETV procedure is considered successful when the patient gets freedom from a shunt 7 and shows clinical evidence of normal intracranial pressure. An ETV procedure is considered to have failed when the patient shows no clinical improvement and ventriculoperitoneal shunt placement is required. 15 , 18 , 21 , 30 Since most ETV failures are encountered within the first 7 months of surgery, as stated by Isaacs et al., 16

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Successful management of symptomatic hydrocephalus using a temporary external ventricular drain with or without endoscopic third ventriculostomy in pediatric patients with germinoma

Rebecca Ronsley, Eric Bouffet, Peter Dirks, James Drake, Abhaya Kulkarni, and Ute Bartels

required for diagnostic purposes in patients with germinoma, many of these patients present with signs and symptoms of hydrocephalus that may require immediate management. A number of surgical interventions are used to treat symptomatic hydrocephalus, including placement of an external ventricular drain (EVD), endoscopic third ventriculostomy (ETV), and ventriculoperitoneal (VP) shunt insertion. VP shunts have been progressively abandoned for patients with pineal germinoma, particularly as surgical hydrocephalus control may only be needed temporarily and ETV is now

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Outcomes and complications of different surgical treatments for idiopathic normal pressure hydrocephalus: a systematic review and meta-analysis

Enrico Giordan, Giorgio Palandri, Giuseppe Lanzino, Mohammad Hassan Murad, and Benjamin D. Elder

D ifferent strategies have been proposed for the treatment of idiopathic normal pressure hydrocephalus (iNPH). Ventriculoperitoneal (VP) or, less commonly, ventriculoatrial (VA) and lumboperitoneal (LP) shunting are the preferred methods for diverting cerebrospinal fluid (CSF). In the past 20 years, endoscopic third ventriculostomy (ETV) has also been suggested as a reasonable alternative, though this is typically recommended when there is evidence of aqueductal stenosis or fourth ventricle outflow obstruction. There are no randomized studies comparing the

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Readmission and reoperation for hydrocephalus: a population-based analysis across the spectrum of age

Allison LeHanka and Joseph Piatt

if no subsequent hospitalization was recorded, the observation was censored at the end of the year. FIG. 1. Workflow for sorting and organization of observations for survival analysis. Figure is available in color online only. From this readmission data set were extracted discharges with procedural codes for operations to treat hydrocephalus and its complications. Both ventricular and lumbar shunts were captured. Shunt insertions and revisions and endoscopic third ventriculostomies (ETVs) without or with choroid plexus coagulation (CPC) were

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Acute low-pressure hydrocephalus: a case series and systematic review of 195 patients

Michael B. Keough, Albert M. Isaacs, Geberth Urbaneja, Jarred Dronyk, Andrew P. Lapointe, and Mark G. Hamilton

. The presence of a shunt prior to ALPH diagnosis and the duration (in months) between the shunt insertion/revision and ALPH diagnosis were recorded. Temporizing interventions of ALPH were categorized into conservative (no active treatment), subatmospheric CSF drainage, and neck wrapping. Definitive treatments were reported as endoscopic third ventriculostomy (ETV), shunt insertion/revision, or both. Each patient’s functional outcome relative to their pre-ALPH status was scored on a 5-point Likert scale, with a lower score representing a better outcome: 1 = return to

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Panventriculomegaly with a wide foramen of Magendie and large cisterna magna

Hiroshi Kageyama, Masakazu Miyajima, Ikuko Ogino, Madoka Nakajima, Kazuaki Shimoji, Ryoko Fukai, Noriko Miyake, Kenichi Nishiyama, Naomichi Matsumoto, and Hajime Arai

structures in prepontine cisterns; UD = urinary dysfunction; + = present; − = absent. Clinical Analysis Medical records and neuroradiological examinations of all patients were retrospectively analyzed by 2 neurosurgeons (H.K. and M.M.). Clinical characteristics were investigated, focusing on the age at disease onset, sex, earliest symptoms, the 3 major symptoms of NPH (dementia, incontinence, and gait disturbance), and surgical procedures (if performed) including ventriculoperitoneal (VP) shunting, lumboperitoneal (LP) shunting, and endoscopic third ventriculostomy