Inês Moreira1, Josué Pereira2, Joana Oliveira3, Sérgio F Salvador4, Rui Vaz5. 1. Faculty of Medicine, University of Porto, Porto, Portugal. Electronic address: moreira.ines5@gmail.com. 2. Faculty of Medicine, University of Porto, Porto, Portugal; Department of Neurosurgery, Centro Hospitalar de São João, Porto, Portugal; Neurosciences Unity, CUF Hospital, Porto, Portugal. Electronic address: josuepereira@sapo.pt. 3. Faculty of Medicine, University of Porto, Porto, Portugal; Department of Neurosurgery, Centro Hospitalar de São João, Porto, Portugal. Electronic address: jago79@gmail.com. 4. Neurosurgical Department of Central Hospital of Maputo, Mozambique; Faculty of Health Sciences, University of Lúrio, Nampula, Mozambique. Electronic address: sfsalvador.neurocirurgia@gmail.com. 5. Faculty of Medicine, University of Porto, Porto, Portugal; Department of Neurosurgery, Centro Hospitalar de São João, Porto, Portugal; Neurosciences Unity, CUF Hospital, Porto, Portugal. Electronic address: ruimcvaz@gmail.com.
Abstract
OBJECTIVES: Endoscopic third ventriculostomy (ETV) emerged as an effective alternative to shunting devices in patients with obstructive hydrocephalus. When ETV fails, neurosurgeons must choose between applying a shunting device or performing a repeat ETV (re-ETV) and attempt a shunt independent outcome. In this series, clinical, surgical and follow-up data from six patients who underwent a second ETV were reviewed. PATIENTS AND METHODS: Between January 2005 and June 2015, six patients underwent re-ETV, with four being children. Causes of obstructive hydrocephalus included idiopathic aqueduct stenosis, congenital aqueduct stenosis, neonatal intraventricular haemorrage, hypothalamic glioma and post-meningitis aqueductal stenosis. Success of the procedure was defined by clinical improvement and shunt independence. RESULTS: Overall success rate of this series was 83.3%, with re-ETV being effective in five of the six patients. The single case of re-ETV failure was observed in the pediatric population and was due to late stoma obstruction by tumoral growth, with a ventriculo-peritoneal shunt (VPS) being placed 6 months after re-ETV. In this series, no mortality and no major permanent morbidity were observed following re-ETV. CONCLUSION: Repeat ETV is a safe and effective procedure and should be an option for treatment of recurrent obstructive hydrocephalus if stoma closure or obstruction is present. Younger age and the presence of a previous VPS should not discourage this procedure.
OBJECTIVES: Endoscopic third ventriculostomy (ETV) emerged as an effective alternative to shunting devices in patients with obstructive hydrocephalus. When ETV fails, neurosurgeons must choose between applying a shunting device or performing a repeat ETV (re-ETV) and attempt a shunt independent outcome. In this series, clinical, surgical and follow-up data from six patients who underwent a second ETV were reviewed. PATIENTS AND METHODS: Between January 2005 and June 2015, six patients underwent re-ETV, with four being children. Causes of obstructive hydrocephalus included idiopathic aqueduct stenosis, congenital aqueduct stenosis, neonatal intraventricular haemorrage, hypothalamic glioma and post-meningitis aqueductal stenosis. Success of the procedure was defined by clinical improvement and shunt independence. RESULTS: Overall success rate of this series was 83.3%, with re-ETV being effective in five of the six patients. The single case of re-ETV failure was observed in the pediatric population and was due to late stoma obstruction by tumoral growth, with a ventriculo-peritoneal shunt (VPS) being placed 6 months after re-ETV. In this series, no mortality and no major permanent morbidity were observed following re-ETV. CONCLUSION: Repeat ETV is a safe and effective procedure and should be an option for treatment of recurrent obstructive hydrocephalus if stoma closure or obstruction is present. Younger age and the presence of a previous VPS should not discourage this procedure.
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