Endoscopic third ventriculostomy (ETV) is an alternative to shunt placement in children with hydrocephalus due to tectal plate gliomas (TPGs). However, controversy remains regarding the amount of ventricular size reduction that should be expected after ETV. This study investigates ventricular size change after ETV for TPGs.
Twenty-two children were identified from a 15-year retrospective database of neuroendoscopic procedures performed at the authors' institution, Children's Hospital of Alabama, in patients with a minimum of 1 year of follow-up. Clinical outcomes, including the need for further CSF diversion and symptom resolution, were recorded. The frontal and occipital horn ratio (FOR) was measured on pre- and postoperative, 1-year, and last follow-up imaging studies.
In 17 (77%) of 22 children no additional procedure for CSF diversion was required. Of those in whom CSF diversion failed, 4 underwent successful repeat ETV and 1 required shunt replacement. Therefore, in 21 (96%) of 22 patients, CSF diversion was accomplished with ETV. Preoperative and postoperative imaging was available for 18 (82%) of 22 patients. The FOR decreased in 89% of children who underwent ETV. The FOR progressively decreased 1.7%, 11.2%, and 12.7% on the initial postoperative, 1-year, and last follow-up images, respectively. The mean radiological follow-up duration for 18 patients was 5.4 years. When ETV failed, the FOR increased at the time of failure in all patients. Failure occurred 1.6 years after initial ETV on average. The mean clinical follow-up period for all 22 patients was 5.3 years. In all cases clinical improvement was demonstrated at the last follow-up.
Endoscopic third ventriculostomy successfully treated hydrocephalus in the extended follow-up period of patients with TPGs. The most significant reduction in ventricular size was observed at the the 1-year followup, with only modest reduction thereafter.
Abbreviations used in this paper:
ETV = endoscopic third ventriculostomy; FOR = frontal and occipital horn ratio; ICP = intracranial pressure; TPG = tectal plate glioma; VP = ventriculoperitoneal.
BargallóN, , OlondoL, , GarciaAI, , CapurroS, , CaralL, & RumiaJ: Functional analysis of third ventriculostomy patency by quantification of CSF stroke volume by using cine phase-contrast MR imaging. AJNR Am J Neuroradiol26:2514–2521, 2005
BargallóN, OlondoL, GarciaAI, CapurroS, CaralL, RumiaJ: Functional analysis of third ventriculostomy patency by quantification of CSF stroke volume by using cine phase-contrast MR imaging. AJNR Am J Neuroradiol26:2514–2521, 2005)| false
BuxtonN, TurnerB, RamliN, VloeberghsM: Changes in third ventricular size with neuroendoscopic third ventriculostomy: a blinded study. J Neurol Neurosurg Psychiatry72:385–387, 200210.1136/jnnp.72.3.385)| false
GrantGA, AvellinoAM, LoeserJD, EllenbogenRG, BergerMS, RobertsTS: Management of intrinsic gliomas of the tectal plate in children. A ten-year review. Pediatr Neurosurg31:170–176, 199910.1159/000028857)| false
KulkarniAV, DrakeJM, MallucciCL, SgourosS, RothJ, ConstantiniS: Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus. J Pediatr155:254–259, 200910.1016/j.jpeds.2009.02.048)| false
O'HayonBB, , DrakeJM, , OssipMG, , TuliS, & ClarkeM: Frontal and occipital horn ratio: A linear estimate of ventricular size for multiple imaging modalities in pediatric hydrocephalus. Pediatr Neurosurg29:245–249, 1998
O'HayonBB, DrakeJM, OssipMG, TuliS, ClarkeM: Frontal and occipital horn ratio: A linear estimate of ventricular size for multiple imaging modalities in pediatric hydrocephalus. Pediatr Neurosurg29:245–249, 199810.1159/000028730)| false
St GeorgeE, NatarajanK, SgourosS: Changes in ventricular volume in hydrocephalic children following successful endoscopic third ventriculostomy. Childs Nerv Syst20:834–838, 200410.1007/s00381-004-0939-x)| false
WellonsJCIII, , TubbsRS, , BanksJT, , GrabbB, , BlountJP, & OakesWJ, et al.: Long-term control of hydrocephalus via endoscopic third ventriculostomy in children with tectal plate gliomas. Neurosurgery51:63–68, 2002
WellonsJCIII, TubbsRS, BanksJT, GrabbB, BlountJP, OakesWJ, : Long-term control of hydrocephalus via endoscopic third ventriculostomy in children with tectal plate gliomas. Neurosurgery51:63–68, 200210.1097/00006123-200207000-00010)| false