PURPOSE: Endoscopic third ventriculostomy (ETV) has gained favour as an effective treatment for obstructive hydrocephalus. However, the timing of ETV failure and the long-term efficacy of revision ETV remain poorly documented. METHODS: A retrospective review was performed of patients undergoing revision ETV between 1999 and 2007. Only those patients in whom there was evidence of a good sustained clinical improvement after the initial ETV were considered candidates for ETV revision. All other patients underwent insertion of a ventriculoperitoneal shunt at the time of ETV failure. Failures that were selected for repeat ETV were subdivided into; "early" if the revision occurred within the first 3 months of the primary procedure and "late" if occurring after this. RESULTS: Ten patients underwent revision ETV (6% of all ETVs performed). Age ranged from 2 months to 32 years (mean 13.6 years). Three "early" revision ETV were performed at a mean of 1.3 months, and there were seven "late" revisions performed at a mean of 27 months. The stoma was closed in seven patients and narrowed in one patient, and a second membrane was found under the original patent stoma in a further two patients. In two patients, a third ETV procedure was performed (both at 1 month after second ETV), and the stoma was closed in both these patients. No patients have required a shunt. CONCLUSION: At last follow-up (mean 38 months), all patients remain well. Revision ETV appears a safe and effective means of managing hydrocephalus-providing there is clinical evidence that the primary procedure was initially effective. It is important to emphasise that patients with an initially successful ETV are by no means "cured".
PURPOSE: Endoscopic third ventriculostomy (ETV) has gained favour as an effective treatment for obstructive hydrocephalus. However, the timing of ETV failure and the long-term efficacy of revision ETV remain poorly documented. METHODS: A retrospective review was performed of patients undergoing revision ETV between 1999 and 2007. Only those patients in whom there was evidence of a good sustained clinical improvement after the initial ETV were considered candidates for ETV revision. All other patients underwent insertion of a ventriculoperitoneal shunt at the time of ETV failure. Failures that were selected for repeat ETV were subdivided into; "early" if the revision occurred within the first 3 months of the primary procedure and "late" if occurring after this. RESULTS: Ten patients underwent revision ETV (6% of all ETVs performed). Age ranged from 2 months to 32 years (mean 13.6 years). Three "early" revision ETV were performed at a mean of 1.3 months, and there were seven "late" revisions performed at a mean of 27 months. The stoma was closed in seven patients and narrowed in one patient, and a second membrane was found under the original patent stoma in a further two patients. In two patients, a third ETV procedure was performed (both at 1 month after second ETV), and the stoma was closed in both these patients. No patients have required a shunt. CONCLUSION: At last follow-up (mean 38 months), all patients remain well. Revision ETV appears a safe and effective means of managing hydrocephalus-providing there is clinical evidence that the primary procedure was initially effective. It is important to emphasise that patients with an initially successful ETV are by no means "cured".
Authors: V Siomin; H Weiner; J Wisoff; G Cinalli; A Pierre-Kahn; C Saint-Rose; R Abbott; H Elran; L Beni-Adani; G Ouaknine; S Constantini Journal: Childs Nerv Syst Date: 2001-09 Impact factor: 1.475
Authors: G Cinalli; C Sainte-Rose; P Chumas; M Zerah; F Brunelle; G Lot; A Pierre-Kahn; D Renier Journal: J Neurosurg Date: 1999-03 Impact factor: 5.115
Authors: Anastasia Arynchyna-Smith; Curtis J Rozzelle; Hailey Jensen; Ron W Reeder; Abhaya V Kulkarni; Ian F Pollack; John C Wellons; Robert P Naftel; Eric M Jackson; William E Whitehead; Jonathan A Pindrik; David D Limbrick; Patrick J McDonald; Mandeep S Tamber; Brent R O'Neill; Jason S Hauptman; Mark D Krieger; Jason Chu; Tamara D Simon; Jay Riva-Cambrin; John R W Kestle; Brandon G Rocque Journal: J Neurosurg Pediatr Date: 2022-04-22 Impact factor: 2.713