Child's Nervous System

, Volume 23, Issue 5, pp 521–526 | Cite as

Risk reduction of subdural collections following endoscopic third ventriculostomy

  • Senta Kurschel
  • Shigeki Ono
  • Shizuo OiEmail author
Original Paper



To evaluate the efficacy and safety using fibrin glue and absorbable hemostats for packing the endoscopic tract in a pediatric population in the prevention of subdural fluid collections after endoscopic third ventriculostomy.

Materials and methods

Twenty-one endoscopic third ventriculostomies were performed in 20 hydrocephalic children with a mean age of 22 months over a 4-year period using uniformly this technique. Six children, with age ranged 6 days to 22 months (mean 9 months), had severe ventriculomegaly with thin brain mantle less than 10 mm. There was no mortality and no permanent morbidity related to the endoscopic procedure. One child developed an asymptomatic collection, which could be managed conservatively and was most likely attributed to the young age of the child and the assumed poor cerebrospinal fluid absorption ability. Lost compliance of the brain parenchyma may play an additional role, which was not related to the thickness of the brain mantle. No adverse effects regarding the material used for sealing were observed over a mean follow-up of 23 months.


Subdural fluid collections could be prevented in 20 out of 21 procedures by using this technique regardless of the thickness of the brain mantle, the application of mixture of fibrin glue and hemostatic agents seems to be safe, and we consider this technique effective in reducing the risk of this potential complication.


Endoscopic third ventriculostomy Subdural collection Fibrin sealant Hemostatic agents 


  1. 1.
    Al-Yamany M, Del Maestro RF (2000) Prevention of subdural fluid collections following transcortical intraventricular and/or paraventricular procedures by using fibrin adhesive. J Neurosurg 92:406–412PubMedGoogle Scholar
  2. 2.
    Bänninger H, Hardegger T, Tobler A, Barth A, Schüpach P, Reinhart W et al (1993) Fibrin glue in surgery: frequent development of inhibitors of bovine thrombin and human factor V. Br J Haematol 85:528–532PubMedCrossRefGoogle Scholar
  3. 3.
    Beni-Adani L, Siomin V, Segev Y, Beni S, Constantini S (2000) Increasing chronic subdural hematoma after endoscopic III ventriculostomy. Childs Nerv Syst 16:402–405PubMedCrossRefGoogle Scholar
  4. 4.
    Caers J, Reekmans A, Jochmans K, Naegels S, Mana F, Urbain D et al (2003) Factor V inhibitor after injection of human thrombin (tissucol) into a bleeding peptic ulcer. Endoscopy 35:542–544PubMedCrossRefGoogle Scholar
  5. 5.
    De Vries J, Menovsky T, Van Gulik S, Wesseling P (2002) Histological effects of fibrin glue on nervous tissue: a safety study in rats. Surg Neurol 57:415–422PubMedCrossRefGoogle Scholar
  6. 6.
    Diez-Martin J, Sikkink RA, Gilchrist GS, Bowie EJW, Fass DN (1990) Development of anti-bovine thrombin antibodies following neurosurgical procedures. Br J Haematol 74:369–370PubMedGoogle Scholar
  7. 7.
    Di Rocco F, Yoshino M, Oi S (2005) Neuroendoscopic transventricular ventriculocystostomy in treatment for intracranial cysts. J Neurosurg (Pediatrics 1) 103:54–60Google Scholar
  8. 8.
    Freudenstein D, Wagner A, Ernemann U, Duffner F (2002) Subdural hygroma as a complication of endoscopic neurosurgery—two case reports. Neurol Med Chir 42:554–559CrossRefGoogle Scholar
  9. 9.
    Fukuhara T, Vorster SJ, Luciano MG (2000) Risk factors for failure of endoscopic third ventriculostomy for obstructive hydrocephalus. Neurosurgery 46:1100–1111PubMedCrossRefGoogle Scholar
  10. 10.
    Hirsch JF, Sainte-Rose C (1991) A new surgical approach to subcortical lesions: balloon inflation and cortical gluing. J Neurosurg 74:1014–1017PubMedGoogle Scholar
  11. 11.
    Hopf NJ, Grunert P, Fries G, Resch KD, Perneczky A (1999) Endoscopic third ventriculostomy: outcome analysis of 100 consecutive procedures. Neurosurgery 44:795–804PubMedCrossRefGoogle Scholar
  12. 12.
    Ito H, Onishi H, Shoin K, Nagatani H (1989) Granuloma caused by oxidized cellulose following craniotomy. Acta Neurochir 100:70–73CrossRefGoogle Scholar
  13. 13.
    Jones RF, Kwok BC, Stening WA, Vonau M (1994) Neuroendoscopic third ventriculostomy. A practical alternative to extracranial shunts in non-communicating hydrocephalus. Acta Neurochir Suppl 61:79–83Google Scholar
  14. 14.
    Kassam A, Nemeto E, Balzer J, Rao G, Welch WC, Kuwabara H et al (2004) Effects of tisseel fibrin glue on the central nervous system of nonhuman primates. Ear Nose Throat J 83:246–248PubMedGoogle Scholar
  15. 15.
    Kim BS, Jallo GI, Kothbauer K, Abbott R (2004) Chronic subdural hematoma as a complication of endoscopic third ventriculostomy. Surg Neurol 62:64–68PubMedCrossRefGoogle Scholar
  16. 16.
    Kothbauer K, Jallo GI, Siffert J, Jimenez E, Allen JC, Epstein FJ (2001) Foreign body reaction to hemastatic materials mimicking recurrent brain tumor. J Neurosurg 95:503–506PubMedGoogle Scholar
  17. 17.
    Macarthur DC, Buxton N, Vloeberghs M, Punt J (2001) The effectiveness of neuroendoscopic interventions in children with brain tumours. Childs Nerv Syst 17:589–594PubMedCrossRefGoogle Scholar
  18. 18.
    Maeda Y, Inamura T, Morioka T, Muratani H, Fukui M (2000) Hemorrhagic subdural effusion complicating an endoscopic III ventriculostomy. Childs Nerv Syst 16:312–314PubMedCrossRefGoogle Scholar
  19. 19.
    Mohanty A, Anandh B, Reddy MS, Sastry KV (1997) Contralateral massive acute subdural collection after endoscopic third ventriculostomy—a case report. Minim Invasive Neurosurg 40:59–61PubMedCrossRefGoogle Scholar
  20. 20.
    Oi S (1996) Recent advances in neuroendoscopic surgery: realistic indications and clinical achievements. Crit Rev Neurosurg 6:64–72Google Scholar
  21. 21.
    Oi S, Hidaka M, Honda Y, Togo K, Shinoda M, Shimoda M et al (1999) Neuroendoscopic surgery for specific forms of hydrocephalus. Childs Nerv Syst 15:56–68PubMedCrossRefGoogle Scholar
  22. 22.
    Oi S, Shimoda M, Shibata M, Honda Y, Togo K, Shinoda M, et al (2000) Pathophysiology of long-standing overt ventriculomegaly in adults. J Neurosurg 92:933–940PubMedGoogle Scholar
  23. 23.
    Oi S, Samii A, Samii M (2005) Frameless free-hand maneuvering of a small-diameter rigid-rod neuroendoscope with a working channel used during high-resolution imaging. J Neurosurg 102:113–118PubMedGoogle Scholar
  24. 24.
    Santamarta D, Diaz Alvarez A, Goncalves JM, Hernandez J (2005) Outcome of endoscopic third ventriculostomy. Results from an unselected series with noncommunicating hydrocephalus. Acta Neurochir 147:377–382CrossRefGoogle Scholar
  25. 25.
    Schlag MG, Hopf R, Zifko U, Redl H (2002) Epileptic seizures following cortical application of fibrin sealants containing tranexamic acid in rats. Acta Neurochir 144:63–69CrossRefGoogle Scholar
  26. 26.
    Schroeder HWS, Niendorf WR, Gaab MR (2002) Complications of endoscopic third ventriculostomy. J Neurosurg 96:1032–1040PubMedCrossRefGoogle Scholar
  27. 27.
    Schroeder HWS, Oertel J, Gaab MR (2004) Incidence of complications in neuroendoscopic surgery. Childs Nerv Syst 20:878–883PubMedCrossRefGoogle Scholar
  28. 28.
    Sgaramella E, Castelli G, Sotgiu S (2004) Chronic subdural collection after endoscopic third ventriculostomy. Acta Neurochir 146:529–530CrossRefGoogle Scholar
  29. 29.
    Strootbandt G (1989) Les localisations des épanchements péricérébraux du nourrison. Neurochirurgie 35:407–409PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  1. 1.Division of Pediatric Neurosurgery, Department of Neurosurgery, School of MedicineJikei UniversityTokyoJapan
  2. 2.Department of NeurosurgeryMedical UniversityGrazAustria

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