Endoscopic third ventriculostomy (ETV) is a routine and safe procedure for therapy of obstructive hydrocephalus. The aim of our study is to evaluate ETV success rate in therapy of obstructive hydrocephalus in pediatric patients formerly treated by ventriculoperitoneal (V-P) shunt implantation. From 2001 till 2011, ETV was performed in 42 patients with former V-P drainage implantation. In all patients, the obstruction in aqueduct or outflow parts of the fourth ventricle was proved by MRI. During the surgery, V-P shunt was clipped and ETV was performed. In case of favourable clinical state and MRI functional stoma, the V-P shunt has been removed 3 months after ETV. These patients with V-P shunt possible removing were evaluated as successful. In our group of 42 patients we were successful in 29 patients (69%). There were two serious complications (4.7%)—one patient died 2.5 years and one patient died 1 year after surgery in consequence of delayed ETV failure. ETV is the method of choice in obstructive hydrocephalus even in patients with former V-P shunt implantation. In case of acute or scheduled V-P shunt surgical revision, MRI is feasible, and if ventricular system obstruction is diagnosed, the hydrocephalus may be solved endoscopically. 1. Introduction Endoscopic third ventriculostomy (ETV) is considered as a routine and safe method for obstructive hydrocephalus treatment. ETV is indicated in hydrocephalus with MRI proven obstruction in aqueduct or outflow parts of the fourth ventricle. For this indication, the ETV success rate reaches 90% [1, 2]. However, some patients with obstructive hydrocephalus were treated by ventriculoperitoneal (V-P) drainage (shunt) implantation even today. The most common reason is endoscopic treatment or acute MRI unavailability, or hyperacute hydrocephalus course. In case of V-P drainage failure in these patients, the possibility of subsequent endoscopic treatment and V-P drainage removal should be evaluated. The purpose of the study is to evaluate the success rate of ETV in the treatment of obstructive hydrocephalus in pediatric patients with previous V-P drainage implantation, with a view of subsequent V-P drainage removal. 2. Materials and Methods In the period of January 2001–December 2011, the ETV was performed in 42 patients with obstructive hydrocephalus, all with previous V-P drainage implantation. The group consisted of 24 boys and 18 girls; the mean age at the time of ETV was 9.5 years. The time between V-P drainage implementation and ETV ranged from 4 months to 12 years. There were 15 patients with congenital
References
[1]
D. Brockmeyer, K. Abtin, L. Carey, and M. L. Walker, “Endoscopic third ventriculostomy: an outcome analysis,” Pediatric Neurosurgery, vol. 28, no. 5, pp. 236–240, 1998.
[2]
M. Gangemi, P. Donati, F. Maiuri, P. Longatti, U. Godano, and C. Mascari, “Endoscopic third ventriculostomy for hydrocephalus,” Minimally Invasive Neurosurgery, vol. 42, no. 3, pp. 128–132, 1999.
[3]
N. J. Hopf, P. Grunert, G. Fries, K. D. M. Resch, and A. Perneczky, “Endoscopic third ventriculostomy: outcome analysis of 100 consecutive procedures,” Neurosurgery, vol. 44, no. 4, pp. 795–806, 1999.
[4]
B. Bilginer, K. K. Oguz, and N. Akalan, “Endoscopic third ventriculostomy for malfunction in previously shunted infants,” Child's Nervous System, vol. 25, no. 6, pp. 683–688, 2009.
[5]
V. Siomin, H. Weiner, J. Wisoff et al., “Repeat endoscopic third ventriculostomy: is it worth trying?” Child's Nervous System, vol. 17, no. 9, pp. 551–555, 2001.
[6]
W. J. Hader, R. L. Walker, S. T. Myles, and M. Hamilton, “Complications of endoscopic third ventriculostomy in previously shunted patients,” Neurosurgery, vol. 63, no. 1, pp. ONS168–ONS174, 2008.
[7]
G. Woodworth, M. J. McGirt, G. Thomas, M. A. Williams, and D. Rigamonti, “Prior CSF shunting increases the risk of endoscopic third ventriculostomy failure in the treatment of obstructive hydrocephalus in adults,” Neurological Research, vol. 29, no. 1, pp. 27–31, 2007.
[8]
R. Lipina, T. Pale？ek, S. Reguli, and M. Ková？ová, “Death in consequence of late failure of endoscopic third ventriculostomy,” Child's Nervous System, vol. 2, pp. 815–819, 2007.
[9]
J. Drake, P. Chumas, J. Kestle et al., “Late rapid deterioration after endoscopic third ventriculostomy: additional cases and review of the literature,” Journal of Neurosurgery, vol. 105, no. 2, pp. 118–126, 2006.
[10]
W. J. Hader, J. Drake, D. Cochrane, O. Sparrow, E. S. Johnson, and J. Kestle, “Death after late failure of third ventriculostomy in children: report of three cases,” Journal of Neurosurgery, vol. 97, no. 1, pp. 211–215, 2002.
[11]
M. Javadpour, P. May, and C. Mallucci, “Sudden death secondary to delayed closure of endoscopic third ventriculostomy,” British Journal of Neurosurgery, vol. 17, no. 3, pp. 266–269, 2003.
[12]
D. Kadrian, J. van Gelder, D. Florida et al., “Long-term reliability of endoscopic third ventriculostomy,” Neurosurgery, vol. 56, no. 6, pp. 1271–1278, 2005.
[13]
R. J. Mobbs, M. Vonau, M. A. Davies et al., “Death after late failure of endoscopic third ventriculostomy: a potential solution,” Neurosurgery, vol. 53, no. 2, pp. 384–386, 2003.
[14]
K. Aquilina, R. J. Edwards, and I. K. Pople, “Routine placement of a ventricular reservoir at endoscopic third ventriculostomy,” Neurosurgery, vol. 53, no. 1, pp. 91–97, 2003.
[15]
S. H. Lee, D. S. Kong, H. J. Seol, and H. J. Shin, “Endoscopic third ventriculostomy in patients with shunt malfunction,” Journal of Korean Neurosurgical Society, vol. 49, no. 4, pp. 217–221, 2011.
[16]
G. Cinalli, C. Sainte-Rose, P. Chumas et al., “Failure of third ventriculostomy in the treatment of aqueductal stenosis in children,” Journal of Neurosurgery, vol. 90, no. 3, pp. 448–454, 1999.
[17]
T. Fukuhara, S. J. Vorster, and M. G. Luciano, “Risk factors for failure of endoscopic third ventriculostomy for obstructive hydrocephalus,” Neurosurgery, vol. 46, no. 5, pp. 1100–1111, 2000.
