Download PDF
Minim Invasive Neurosurg 2010; 53(4): 159-163
DOI: 10.1055/s-0030-1268415
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Value of Endoscopic Third Ventriculostomy instead of Shunt Revision

J. Baldauf1 , M. J. Fritsch1 , J. Oertel2 , M. R. Gaab3 , H. Schröder1
  • 1Department of Neurosurgery, Ernst-Moritz-Arndt University, Greifswald, Germany
  • 2Department of Neurosurgery, Universitaetsmedizin, Mainz, Germany
  • 3Department of Neurosurgery, Hospital Hannover Nordstadt, Hannover, Germany
Further Information

Publication History

Publication Date:
03 December 2010 (online)

    Permissions and Reprints

Abstract

Background: The purpose of this study was to analyze the value of endoscopic third ventriculostomy (ETV) in patients with shunt malfunction or infection.

Methods: ETV was performed in 263 patients in Greifswald between 1993 and 2008. We reviewed the data of all patients with previous shunts who underwent ETV instead of shunt revision. The procedure was successful when subsequent shunt implantation was avoided.

Results: Neuroendoscopy was performed in 30/31 previously shunted patients. The average age of the patients was 26.4 years ranging from 6 months to 69 years (male/female ratio: 18/12). The primary cause of hydrocephalus was aqueductal stenosis in 11, myelomeningocele in 5, posthemorrhagic in 5, postmeningitic in 3, tumor-related obstruction in 2, supracerebellar arachnoid cyst in 2, posttraumatic in 1 and a complex congenital hydrocephalus in 1. ETV was successful in 18 patients (60%) with a mean follow-up period of 51 months. 12 patients (40%) did not benefit from ETV and required a permanent shunt. 11 of them received the shunt within 3 months after failed ETV. ETV failed in all children <2 years of age. A benefit of ETV without subsequent shunt procedures was recognized in 18/27 (66.7%) with an obstructive and 0/3 (0%) patients with a communicating cause of the hydrocephalus. Complications occurred in 2 patients (6.7%).

Conclusions: ETV is a potential treatment option when shunts fail in patients with obstructive hydrocephalus. If MR imaging shows no obstruction, a shunt revision is recommended. Patients with a posthemorrhagic and postmeningitic hydrocephalus are poor candidates for ETV.

Key words

ventriculoperitoneal shunt - hydrocephalus - ventriculostomy - third ventriculostomy - endoscopy

References

  • 1 Schroeder HW, Oertel J, Gaab MR. Endoscopic treatment of cerebrospinal fluid pathway obstructions.  Neurosurgery. 2008;  62 (6 Suppl 3) 1084-1092
    Google Scholar
  • 2 Jones RF, Stening WA, Kwok BC. et al . Third ventriculostomy for shunt infections in children.  Neurosurgery. 1993;  32 855-859
    Google Scholar
  • 3 Buxton N, Macarthur D, Robertson I. et al . Neuroendoscopic third ventriculostomy for failed shunts.  Surg Neurol. 2003;  60 201-203
    Google Scholar
  • 4 Boschert J, Hellwig D, Krauss JK. Endoscopic third ventriculostomy for shunt dysfunction in occlusive hydrocephalus: long-term follow-up and review.  J Neurosurg. 2003;  98 1032-1039
    Google Scholar
  • 5 Hader WJ, Walker RL, Myles ST. et al . Complications of endoscopic third ventriculostomy in previously shunted patients.  Neurosurgery. 2008;  63 (1 Suppl 1) ONS168-ONS174
    Google Scholar
  • 6 Cinalli G, Salazar C, Mallucci C. et al . The role of endoscopic third ventriculostomy in the management of shunt malfunction.  Neurosurgery. 1998;  43 1323-1327
    Google Scholar
  • 7 O’Brien DF, Javadpour M, Collins DR. et al . Endoscopic third ventriculostomy: an outcome analysis of primary cases and procedures performed after ventriculoperitoneal shunt malfunction.  J Neurosurg. 2005;  103 (5 Suppl) 393-400
    Google Scholar
  • 8 Woodworth G, McGirt MJ, Thomas G. et al . Prior CSF shunting increases the risk of endoscopic third ventriculostomy failure in the treatment of obstructive hydrocephalus in adults.  Neurol Res. 2007;  29 27-31
    Google Scholar
  • 9 Yamamoto M, Oka K, Ikeda K. et al . Percutaneous flexible neuroendoscopic ventriculostomy in patients with shunt malfunction as an alternative procedure to shunt revision.  Surg Neurol. 1994;  42 218-223
    Google Scholar
  • 10 Grunert P, Charalampaki P, Hopf N. et al . The role of third ventriculostomy in the management of obstructive hydrocephalus.  Minim Invas Neurosurg. 2003;  46 16-21
    Google Scholar
  • 11 Gangemi M, Mascari C, Maiuri F. et al . Long-term outcome of endoscopic third ventriculostomy in obstructive hydrocephalus.  Minim Invas Neurosurg. 2007;  50 265-269
    Google Scholar
  • 12 Choi JU, Kim DS, Kim SH. Endoscopic surgery for obstructive hydrocephalus.  Yonsei Med J. 1999;  40 600-607
    Google Scholar
  • 13 Cinalli G, Sainte-Rose C, Chumas P. et al . Failure of third ventriculostomy in the treatment of aqueductal stenosis in children.  Neurosurg Focus. 1999;  6 e3
    Google Scholar
  • 14 Jones RF, Kwok BC, Stening WA. et al . The current status of endoscopic third ventriculostomy in the management of non-communicating hydrocephalus.  Minim Invas Neurosurg. 1994;  37 28-36
    Google Scholar
  • 15 Siomin V, Cinalli G, Grotenhuis A. et al . Endoscopic third ventriculostomy in patients with cerebrospinal fluid infection and/or hemorrhage.  J Neurosurg. 2002;  97 519-524
    Google Scholar
  • 16 Blasberg R, Johnson D, Fenstermacher J. Absorption resistance of cerebrospinal fluid after subarachnoid hemorrhage in the monkey; effects of heparin.  Neurosurgery. 1981;  9 686-691
    Google Scholar
  • 17 Dorai Z, Hynan LS, Kopitnik TA. et al . Factors related to hydrocephalus after aneurysmal subarachnoid hemorrhage.  Neurosurgery. 2003;  52 763-769
    Google Scholar
  • 18 Ellington E, Margolis G. Block of arachnoid villus by subarachnoid hemorrhage.  J Neurosurg. 1969;  30 651-657
    Google Scholar
  • 19 Brockmeyer D, Abtin K, Carey L. et al . Endoscopic third ventriculostomy: an outcome analysis.  Pediatr Neurosurg. 1998;  28 236-240
    Google Scholar
  • 20 Teo C, Jones R. Management of hydrocephalus by endoscopic third ventriculostomy in patients with myelomeningocele.  Pediatr Neurosurg. 1996;  25 57-63
    Google Scholar
  • 21 Spennato P, Cinalli G, Ruggiero C. et al . Neuroendoscopic treatment of multiloculated hydrocephalus in children.  J Neurosurg. 2007;  106 (1 Suppl) 29-35
    Google Scholar
  • 22 Cinalli G. Alternatives to shunting.  Childs Nerv Syst. 1999;  15 (11–12) 718-731
    Google Scholar
  • 23 Johnston I, Teo C. Disorders of CSF hydrodynamics.  Childs Nerv Syst. 2000;  16 (10–11) 776-799
    Google Scholar
  • 24 Kulkarni AV, Drake JM, Mallucci CL. et al . Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus.  J Pediatr. 2009;  155 254-259
    Google Scholar
  • 25 Sainte-Rose C, Cinalli G, Roux FE. et al . Management of hydrocephalus in pediatric patients with posterior fossa tumors: the role of endoscopic third ventriculostomy.  J Neurosurg. 2001;  95 791-797
    Google Scholar
  • 26 Schroeder HW, Niendorf WR, Gaab MR. Complications of endoscopic third ventriculostomy.  J Neurosurg. 2002;  96 1032-1040
    Google Scholar
  • 27 Hopf NJ, Grunert P, Fries G. et al . Endoscopic third ventriculostomy: outcome analysis of 100 consecutive procedures.  Neurosurgery. 1999;  44 795-804
    Google Scholar
  • 28 Fritsch MJ, Doerner L, Kienke S. et al . Hydrocephalus in children with posterior fossa tumors: role of endoscopic third ventriculostomy.  J Neurosurg. 2005;  103 (1 Suppl) 40-42
    Google Scholar
  • 29 Ruggiero C, Cinalli G, Spennato P. et al . Endoscopic third ventriculostomy in the treatment of hydrocephalus in posterior fossa tumors in children.  Childs Nerv Syst. 2004;  20 828-833
    Google Scholar
  • 30 Macarthur DC, Buxton N, Punt J. et al . The role of neuroendoscopy in the management of brain tumours.  Br J Neurosurg. 2002;  16 465-470
    Google Scholar

Correspondence

J. Baldauf

Department of Neurosurgery

Ernst-Moritz-Arndt University

Sauerbruchstraße

17475 Greifswald

Germany

Phone: +49/3834/866 163

Fax: +49/3834/866 164

Email: baldauf@uni-greifswald.de

      >