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Neurosurgical Forum: Letters to the Editor To The Editor W. Peter Vandertop , M.D. Amsterdam, The Netherlands A. van der Zwan , M.D. Rudolf M. Verdaasdonk , Ph.D. Utrecht, The Netherlands 919 921 Abstract Since its description by Dandy in 1922, several techniques have been used to perform third ventriculostomy under endoscopic control. Except for the blunt technique, in which the endoscope is used by itself to create the opening in the floor of the third ventricle, the other

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Abhaya V. Kulkarni, James M. Drake, Derek C. Armstrong and Peter B. Dirks

no change between the pre- and postoperative scores yielded probability values of less than 0.0001 for Group 1 and 0.02 for Group 2. However, the difference between Group 1 and Group 2 was not significant (p = 0.43). Discussion Endoscopic third ventriculostomy is gaining popularity as an alternative to CSF shunt placement in selected cases of hydrocephalus. One unresolved issue that emerges during follow-up examination of a patient who has undergone ETV is determining the imaging correlates of failure and success. The two particular correlates of interest have been

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Walter J. Hader, James Drake, Douglas Cochrane, Owen Sparrow, Edward S. Johnson and John Kestle

C omplications associated with the treatment of ob-Vancouver, Canada, or the Southampton General Hospital, structive hydrocephalus with third ventriculostomy Southampton, United Kingdom, and who had died after unare uncommon, 3, 7, 11, 18 but they are often serious in dergoing a successful third ventriculostomy for obstructive nature, 1, 2, 8, 14 although they are rarely fatal. 16 Late failure of hydrocephalus. Patient records were obtained and the folthird ventriculostomy is often heralded by the recurrence of lowing data were recorded: diagnosis, age at

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Neurosurgical Forum: Letters to the Editor To The Editor Vitaly Siomin , M.D. Shlomi Constantini , M.D. Tel-Aviv Sourasky Medical Center Tel Aviv, Israel 940 940 Abstract Object. Endoscopic third ventriculostomy (ETV) is the treatment of choice for occlusive (noncommunicating) hydrocephalus. Nevertheless, its routine use in patients who have previously undergone shunt placement is still not generally accepted. The authors' aim was to investigate the long-term effects of ETV in a group of

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Neil Buxton

Neuroendoscopic third ventriculostomy is becoming increasingly popular as the primary mode of therapy for patients with noncommunicating hydrocephalus. In this article the author reviews the procedure and its indications, and highlights its complications. It can, without doubt, be recommended as the first line treatment for hydrocephalus and also in cases in which shunt malfunction or infection occurs.

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Jeffrey P. Greenfield, Caitlin Hoffman, Eugenia Kuo, Paul J. Christos and Mark M. Souweidane

. When the fenestration created was judged to be sufficient, the endoscope was used to evaluate the prepontine subarachnoid space for the presence of scarring or adhesions and unfenestrated membranes of Liliequist. If necessary, blunt perforation and balloon dilation could be used on scarred or adherent membranes in a fashion similar to that used on the floor of the third ventricle. At the completion of the procedure irrigation, was briefly held. The adequacy of the third ventriculostomy was then judged by the to-and-fro motion of the free edges of the fenestrations

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George I. Jallo, Karl F. Kothbauer and I. Rick Abbott

The traditional treatment for all forms of hydrocephalus has been the implantation of ventricular shunt systems; however, these systems have inherent tendencies toward complications such as malfunction and infection. A significant advance in the treatment of hydrocephalus has been the evolution of endoscopy. The recent technological advances in this field have led to a renewed interest in endoscopic third ventriculostomy as the treatment of choice for obstructive hydrocephalus. Although several different endoscopes are available, the authors favor a rigid one to perform a blunt fenestration of the third ventricle floor. This description of the technique stresses the nuances for successful completion of this procedure.

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Neurosurgical Forum: Letters to the Editor To The Editor Richard J. Edwards , F.R.C.S. Ian K. Pople , M.D., F.R.C.S.(SN) Frenchay Hospital Bristol, United Kingdom 649 651 Abstract Late failure following successful third ventriculostomy for obstructive hydrocephalus is rare, and death caused by failure of a previously successful third ventriculostomy has been reported only once. The authors present three patients who died as a result of increased intracranial pressure (ICP) after late failure of

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Paul J. Schmitt and John A. Jane Jr.

hydrocephalus by using a urethroscope to access the lateral ventricles, where he performed a fulguration of the choroid plexus. 24 However, Walter Dandy is considered by most to be the father of neuroendoscopy. In 1922 Dandy described ventriculoscopy, 5 as well as a technique for performing the third ventriculostomy as a treatment for hydrocephalus via frontal and subtemporal approaches. 6 Dandy's open attempts at puncturing the floor of the ventricle were true skull base approaches. These challenging forays into the base of the brain yielded dissatisfaction with the

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Ryan Alkins, Yuexi Huang, Dan Pajek and Kullervo Hynynen

T reatment options for hydrocephalus include CSF shunting procedures or endoscopic third ventriculostomy (ETV). In the developed world, ETV is often the preferred treatment for obstructive hydrocephalus as it avoids shunt dependency and the need for permanently implanted hardware. 6 In the developing world, ETV is even more desirable, given the barriers to accessing timely and competent neurosurgical care in the event of shunt malfunction or infection. Endoscopic third ventriculostomy is not without risk, however, with morbidity and mortality reported in