Failure of third ventriculostomy in the treatment of aqueductal stenosis in children

View More View Less
  • 1 Université René Decartes—Paris V. Department of Pediatric Neurosurgery and Pediatric Radiology, Hôpital Necker—Enfants Malades, Paris, France; Leeds General Infirmary, Leeds, England; and Department of Neurosurgery, Hôpital Lariboisiere, Paris, France
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Print or Print + Online

Object. The goal of this study was to analyze the types of failure and long-term efficacy of third ventriculostomy in children.

Methods. The authors retrospectively analyzed clinical data obtained in 213 children affected by obstructive triventricular hydrocephalus who were treated by third ventriculostomy between 1973 and 1997. There were 120 boys and 93 girls. The causes of the hydrocephalus included: aqueductal stenosis in 126 cases; toxoplasmosis in 23 cases, pineal, mesencephalic, or tectal tumor in 42 cases; and other causes in 22 cases. In 94 cases, the procedure was performed using ventriculographic guidance (Group I) and in 119 cases by using endoscopic guidance (Group II). In 19 cases (12 in Group I and seven in Group II) failure was related to the surgical technique. Three deaths related to the technique were observed in Group I. For the remaining patients, Kaplan—Meier survival analysis showed a functioning third ventriculostomy rate of 72% at 6 years with a mean follow-up period of 45.5 months (range 4 days–17 years). No significant differences were found during long-term follow up between the two groups. In Group I, a significantly higher failure rate was seen in children younger than 6 months of age, but this difference was not observed in Group II. Thirty-eight patients required reoperation (21 in Group I and 17 in Group II) because of persistent or recurrent intracranial hypertension. In 29 patients shunt placement was necessary. In nine patients in whom there was radiologically confirmed obstruction of the stoma, the third ventriculostomy was repeated; this was successful in seven cases. Cine phase-contrast (PC) magnetic resonance (MR) imaging studies were performed in 15 patients in Group I at least 10 years after they had undergone third ventriculostomy (range 10–17 years, median 14.3 years); this confirmed long-term patency of the stoma in all cases.

Conclusions. Third ventriculostomy effectively controls obstructive triventricular hydrocephalus in more than 70% of children and should be preferred to placement of extracranial cerebrospinal shunts in this group of patients. When performed using ventriculographic guidance, the technique has a higher mortality rate and a higher failure rate in children younger than 6 months of age and is, therefore, no longer preferred. When third ventriculostomy is performed using endoscopic guidance, the same long-term results are achieved in children younger than 6 months of age as in older children and, thus, patient age should no longer be considered as a contraindication to using the technique. Delayed failures are usually secondary to obstruction of the stoma and often can be managed by repeating the procedure. Midline sagittal T2-weighted MR imaging sequences combined with cine PC MR imaging flow measurements provide a reliable tool for diagnosis of aqueductal stenosis and for ascertaining the patency of the stoma during follow-up evaluation.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
  • 1.

    Cinalli G, , Sainte-Rose C, & Simon I, et al: Sylvian aqueduct syndrome and global rostral midbrain dysfunction associated with shunt malfunction. J Neurosurg 90:227236, 1999 Cinalli G, Sainte-Rose C, Simon I, et al: Sylvian aqueduct syndrome and global rostral midbrain dysfunction associated with shunt malfunction. J Neurosurg 90:227–236, 1999

    • Search Google Scholar
    • Export Citation
  • 2.

    Cochrane D, , Kestle J, & Steinbok P, et al: Model for the cost analysis of shunted hydrocephalic children. Pediatr Neurosurg 23:1419, 1995 Cochrane D, Kestle J, Steinbok P, et al: Model for the cost analysis of shunted hydrocephalic children. Pediatr Neurosurg 23:14–19, 1995

    • Search Google Scholar
    • Export Citation
  • 3.

    Cohen AR: Illustrative case. Tech Neurosurg 1:44147, 1995 Cohen AR: Illustrative case. Tech Neurosurg 1:44–147, 1995

  • 4.

    Dandy WE: An operative procedure for hydrocephalus. Bull Johns Hopkins Hosp 33:189190, 1922 Dandy WE: An operative procedure for hydrocephalus. Bull Johns Hopkins Hosp 33:189–190, 1922

    • Search Google Scholar
    • Export Citation
  • 5.

    Drake JM: Ventriculostomy for treatment of hydrocephalus. Neurosurg Clin North Am 4:657666, 1993 Drake JM: Ventriculostomy for treatment of hydrocephalus. Neurosurg Clin North Am 4:657–666, 1993

    • Search Google Scholar
    • Export Citation
  • 6.

    Goumnerova LC, & Frim DM: Treatment of hydrocephalus with third ventriculocisternostomy: outcome and CSF flow patterns. Pediatr Neurosurg 27:149152, 1997 Goumnerova LC, Frim DM: Treatment of hydrocephalus with third ventriculocisternostomy: outcome and CSF flow patterns. Pediatr Neurosurg 27:149–152, 1997

    • Search Google Scholar
    • Export Citation
  • 7.

    Guiot G: Ventriculo-cisternostomy for stenosis of the aqueduct of Sylvius. Puncture of the floor of the third ventricle with a leucotome under television control. Acta Neurochir 28:275289, 1973 Guiot G: Ventriculo-cisternostomy for stenosis of the aqueduct of Sylvius. Puncture of the floor of the third ventricle with a leucotome under television control. Acta Neurochir 28:275–289, 1973

    • Search Google Scholar
    • Export Citation
  • 8.

    Guiot G, , Derome P, & Hertzog E, et al: Ventriculo-cisternostomie sous controle radioscopique pour hydrocéphalie obstructive. Presse Med 76:19231926, 1968 Guiot G, Derome P, Hertzog E, et al: Ventriculo-cisternostomie sous controle radioscopique pour hydrocéphalie obstructive. Presse Med 76:1923–1926, 1968

    • Search Google Scholar
    • Export Citation
  • 9.

    Hirsch JF: Percutaneous ventriculostomies in noncommunicating hydrocephalus, in Choux M (ed): Shunts and Problems in Shunts. Monographs in Neural Sciences, Vol 8. Basel: Karger, pp 170178 Hirsch JF: Percutaneous ventriculostomies in noncommunicating hydrocephalus, in Choux M (ed): Shunts and Problems in Shunts. Monographs in Neural Sciences, Vol 8. Basel: Karger, pp 170–178

    • Search Google Scholar
    • Export Citation
  • 10.

    Hirsch JF, , Hirsch E, & Sainte Rose C, et al: Stenosis of the aqueduct of Sylvius. Etiology and treatment. J Neurosurg Sci 30:2939, 1986 Hirsch JF, Hirsch E, Sainte Rose C, et al: Stenosis of the aqueduct of Sylvius. Etiology and treatment. J Neurosurg Sci 30:29–39, 1986

    • Search Google Scholar
    • Export Citation
  • 11.

    Hoffman HJ, , Harwood-Nash D, & Gilday DL: Percutaneous third ventriculostomy in the management of noncommunicating hydrocephalus. Neurosurgery 7:313321, 1980 Hoffman HJ, Harwood-Nash D, Gilday DL: Percutaneous third ventriculostomy in the management of noncommunicating hydrocephalus. Neurosurgery 7:313–321, 1980

    • Search Google Scholar
    • Export Citation
  • 12.

    Huang YP, , Wolf BS, & Antin SP, et al: Angiographic features of aqueductal stenosis. AJR 104:90108, 1968 Huang YP, Wolf BS, Antin SP, et al: Angiographic features of aqueductal stenosis. AJR 104:90–108, 1968

    • Search Google Scholar
    • Export Citation
  • 13.

    Jakubowski J, & Jefferson A: Axial enlargement of the 3rd ventricle, and displacement of the brain-stem in benign aqueduct stenosis. J Neurol Neurosurg Psychiatry 35:114123, 1972 Jakubowski J, Jefferson A: Axial enlargement of the 3rd ventricle, and displacement of the brain-stem in benign aqueduct stenosis. J Neurol Neurosurg Psychiatry 35:114–123, 1972

    • Search Google Scholar
    • Export Citation
  • 14.

    Jones RF, , Kwok BC, & Stening WA, et al: The current status of endoscopic third ventriculostomy in the management of noncommunicating hydrocephalus. Minim Invasive Neurosurg 37:2836, 1994 Jones RF, Kwok BC, Stening WA, et al: The current status of endoscopic third ventriculostomy in the management of noncommunicating hydrocephalus. Minim Invasive Neurosurg 37:28–36, 1994

    • Search Google Scholar
    • Export Citation
  • 15.

    Jones RFC, , Kwok BCT, & Stening WA, et al: Neuroendoscopic third ventriculostomy. A practical alternative to extracranial shunts in non-communicating hydrocephalus. Acta Neurochir Suppl 61:7983, 1994 Jones RFC, Kwok BCT, Stening WA, et al: Neuroendoscopic third ventriculostomy. A practical alternative to extracranial shunts in non-communicating hydrocephalus. Acta Neurochir Suppl 61:79–83, 1994

    • Search Google Scholar
    • Export Citation
  • 16.

    Jones RFC, , Stening WA, & Brydon M: Endoscopic third ventriculostomy. Neurosurgery 26:8692, 1990 Jones RFC, Stening WA, Brydon M: Endoscopic third ventriculostomy. Neurosurgery 26:86–92, 1990

    • Search Google Scholar
    • Export Citation
  • 17.

    Lapras C, , Bret P, & Tommasi M, et al: Les sténoses de l'aqueduc de Sylvius. Neurochirurgie 26 (Suppl 1):1152, 1980 Lapras C, Bret P, Tommasi M, et al: Les sténoses de l'aqueduc de Sylvius. Neurochirurgie 26 (Suppl 1):1–152, 1980

    • Search Google Scholar
    • Export Citation
  • 18.

    Lev S, , Bhadelia RA, & Estin D, et al: Functional analysis of third ventriculostomy patency with phase-contrast MRI velocity measurements. Neuroradiology 39:175179, 1997 Lev S, Bhadelia RA, Estin D, et al: Functional analysis of third ventriculostomy patency with phase-contrast MRI velocity measurements. Neuroradiology 39:175–179, 1997

    • Search Google Scholar
    • Export Citation
  • 19.

    Pierre-Kahn A, , Renier D, & Bombois B, et al: Place de la ventriculo-cisternostomie dans le traitement des hydrocephalies non communicantes. Neurochirurgie 21:557569, 1975 Pierre-Kahn A, Renier D, Bombois B, et al: Place de la ventriculo-cisternostomie dans le traitement des hydrocephalies non communicantes. Neurochirurgie 21:557–569, 1975

    • Search Google Scholar
    • Export Citation
  • 20.

    Sainte-Rose C, & Chumas P: Endoscopic third ventriculostomy. Tech Neurosurg 1:176184, 1995 Sainte-Rose C, Chumas P: Endoscopic third ventriculostomy. Tech Neurosurg 1:176–184, 1995

    • Search Google Scholar
    • Export Citation
  • 21.

    Sainte-Rose C, , Piatt JH, & Renier D, et al: Mechanical complications in shunts. Pediatr Neurosurg 17:29 1991 Sainte-Rose C, Piatt JH, Renier D, et al: Mechanical complications in shunts. Pediatr Neurosurg 17:2–9 1991

    • Search Google Scholar
    • Export Citation
  • 22.

    Sgouros S, , Malluci C, & Walsh AR, et al: Long-term complications of hydrocephalus. Pediatr Neurosurg 23:127132, 1995 Sgouros S, Malluci C, Walsh AR, et al: Long-term complications of hydrocephalus. Pediatr Neurosurg 23:127–132, 1995

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 748 149 11
Full Text Views 161 13 0
PDF Downloads 82 9 0
EPUB Downloads 0 0 0