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Endoscopic third ventriculostomy for obstructive hydrocephalus in children younger than 6 months of age: is it a first-choice method?

Child's Nervous System volume 24, pages 1021–1027 (2008)Cite this article

Abstract

Introduction

Endoscopic third ventriculostomy (ETV) is considered a safe procedure and is a method of choice in treatment of obstructive hydrocephalus nowadays. In case of Sylvian aqueduct stenosis, the success rate reaches 90%. In children younger than 6 to 24 months, respectively, however, some authors report lower effectiveness ranging between 0% and 64%. The reasons of ETV failure are discussed: hyporesorption in patients with obstruction as a consequence of hemorrhage or infection, suboptimal ETV performance, especially in premature newborns, or the theory of different cerebrospinal fluid circulation in newborn babies.

Materials and methods

Between January 2005 and December 2006 in our clinic, 14 patients younger than 6 months having presented with obstructive hydrocephalus were treated endoscopically. Obstruction was revealed by preoperative magnetic resonance imaging. The etiology of hydrocephalus was congenital aqueduct stenosis in five patients, posthemorrhagic obstruction in eight patients, and combination of posthemorrhagic and postinfection etiology in one patient. ETV was considered successful when no shunt operation was needed in the patient.

Results

ETV was successful in eight patients who experienced regression of signs of intracranial hypertension and were not forced to undergo ventriculo-peritoneal (V-P) shunting. In one patient, a successful repeat ETV was performed. In the remaining six patients, V-P shunt implantation was necessary. Total success rate in our group of patients was 57%. The only complication was subdural hygroma in one patient requiring evacuation.

Conclusion

Based on our experience, we recommend ETV as the method of choice in children younger than 6 month of age.

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References

  1. Baldauf J, Oertel J, Gaab MR, Schroeder WS (2007) Endoscopic third ventriculostomy in children younger than 2 years of age. Childs Nerv Syst 23:623–626

    PubMed  Article  Google Scholar 

  2. Balthasar AJR, Kort H, Cornips EMJ, Beuls EAM, Weber JW, Vles JSH (2007) Analysis of the success and failure of endoscopic third ventriculostomy in infants less than 1 year of age. Childs Nerv Syst 23:151–155

    PubMed  Article  CAS  Google Scholar 

  3. Brockmeyer D, Abtin K, Carey L, Walker LM (1998) Endoscopic third ventriculostomy: an outcome analysis. Pediatr Neurosurg 28:236–240

    PubMed  Article  CAS  Google Scholar 

  4. Buxton A, Macarthur D, Mallucci C, Punt J, Vloeberghs M (1998) Neuroendoscopy in the premature population. Childs Nerv Syst 14:649–652

    PubMed  Article  CAS  Google Scholar 

  5. Buxton A, Macarthur D, Mallucci C, Punt J, Vloeberghs M (1998) Neuroendoscopic third ventriculostomy in patients less then 1 year old. Pediatr Neurosurg 29:73–76

    PubMed  Article  CAS  Google Scholar 

  6. Chatterjee S (2006) How common is aqueductal stenosis in infants in the developing world? Childs Nerv Syst 22:1046 (Abstract)

    Google Scholar 

  7. Cinalli G, Sainte-Rose C, Chumas P et al (1999) Failure of third ventriculostomy in the treatment of aqueductal stenosis in children. J Neurosurg 90:448–454

    PubMed  CAS  Article  Google Scholar 

  8. Cinnali G, Spennato P, Ruggiero C et al (2007) Complications following endoscopic intracranial procedures in children. Childs Nerv Syst 23:633–644

    Article  Google Scholar 

  9. De Ribaupierre S, Rilliet B, Vernet O et al (2007) Third ventriculostomy vs ventriculoperitoneal shunt in pediatric obstructive hydrocephalus: results from a Swiss series and literature review. Childs Nerv Syst 23:527–533

    PubMed  Article  Google Scholar 

  10. Di Rocco C, Cinalli G, Massimi L, Spennato P, Cianciulli E, Tamburrini G (2006) Endoscopic third ventriculostomy in the treatment of hydrocephalus in pediatric patients. Adv Tech Stand Neurosurg 31:119–219

    PubMed  Article  Google Scholar 

  11. DiRocco C, Marchese E, Velardi F (1994) A survey of the first complication of newly implanted CSF shunt devices for the treatment of non tumoral hydrocephalus. Cooperative survey of the 1991–1992 Education Committee on the ISPN. Childs Nerv Syst 10:321–327

    Article  CAS  Google Scholar 

  12. Drake J, Chumas P, Kestle J, Pierre-Kahn A, Vinchon M, Brown J, Pollack IF, Arai H (2006) Late rapid deterioration after endoscopic third ventriculostomy: additional cases and review of the literature. J Neurosurg (Pediatrics) 105:118–126

    Article  Google Scholar 

  13. Drake J, Kestle J, Milner R et al (1998) Randomized trial of cerebrospinal fluid shunt valve design in pediatric hydrocephalus. Neurosurgery 43:294–305

    PubMed  Article  CAS  Google Scholar 

  14. Fritsch MJ, Kienke S, Ankermann T, Padoin M, Mehdorn HM (2005) Endoscopic third ventriculostomy in infants. J Neurosurg (Pediatrics 1) 103:50–53

    Google Scholar 

  15. Fukuhara T, Vorster SJ, Luciano MG (2000) Risk factors for failure of endoscopic third ventriculostomy for obstructive hydrocephalus. Neurosurgery 46:1100–1111

    PubMed  Article  CAS  Google Scholar 

  16. Galbreath E, Kim SJ, Park K, Brenner M, Messing A (1995) Overexpression of TGF-beta 1 in the central nervous system of transgenic mice results in hydrocephalus. J Neuropathol Exp Neurol 54:339–349

    PubMed  Article  CAS  Google Scholar 

  17. Gangemi M, Donati P, Maiuri F, Longatti P, Godano U, Mascari C (1999) Endoscopic third ventriculostomy for hydrocephalus. Minim Invasive Neurosurg 42:128–132

    PubMed  CAS  Google Scholar 

  18. Gorayeb RP, Cavalheiro S, Zymberg ST (2004) Endoscopic third ventriculostomy in children younger than 1 year of age. J Neurosurg (Pediatrics 5) 100:427–429

    Google Scholar 

  19. Heep A, Bartmann P, Stoffel-Wagner B et al (2006) Cerebrospinal fluid obstruction and malabsorption in human neonatal hydrocephaly. Childs Nerv Syst 22:1249–1255

    PubMed  Article  Google Scholar 

  20. Hopf NJ, Grunert P, Fries G et al (1999) Endoscopic third ventriculostomy: outcome analysis of 100 consecutive procedures. Neurosurgery 44:795–806

    PubMed  Article  CAS  Google Scholar 

  21. Javadpour M, Malluci C, Brodbelt A, Golash A, May P (2001) The impact of third ventriculostomy on the management of newly diagnosed hydrocephalus in infants. Pediatr Neurosurg 35:131–135

    PubMed  Article  CAS  Google Scholar 

  22. Kadrian D, Gelder J, Florida D, Jones R, Vonau M, Teo Ch, Stening W, Kwok B (2005) Long-term reliability of endoscopic third ventriculostomy. Neurosurgery 56:1271–1278

    PubMed  Article  Google Scholar 

  23. Kitazawa K, Tada T (1994) Elevation of transforming growth factor beta1 level in cerebrospinal fluid of patients with communicating hydrocephalus after subarachnoid hemorrhage. Stroke 25:1400–1404

    PubMed  CAS  Google Scholar 

  24. Koch D, Wagner W (2004) Endoscopic third ventriculostomy in infants of less 1 year of age: which factors influence the outcome? Childs Nerv Syst 20:405–411

    PubMed  Article  Google Scholar 

  25. Koch-Wiewrodt D, Wagner W (2006) Success and failure of endoscopic third ventriculostomy in young infants: are there different age distributions? Childs Nerv Syst 22:1537–1541

    PubMed  Article  Google Scholar 

  26. Kombogiorgas D, Sgouros S (2006) Assessment of the influence of operative factors in the success of endoscopic third ventriculostomy in children. Childs Nerv Syst 22:1256–1262

    PubMed  Article  CAS  Google Scholar 

  27. Levy ML, Masri LS, McComb JG (1997) Outcome for preterm infants with germinal matrix hemorrhage and progressive hydrocephalus. Neurosurgery 41:1111–1118

    PubMed  Article  CAS  Google Scholar 

  28. Mohanty A, Vasudev MK, Sampath S, Radhesh S, Kolluri VRS (2002) Failed endoscopic third ventriculostomy in children: management option. Pediatr Neurosurg 37:304–309

    PubMed  Article  Google Scholar 

  29. Oi S, Di Rocco C (2006) Proposal of “evolution theory in cerebrospinal fluid dynamics” and minor pathway hydrocephalus in developing immature brain. Childs Nerv Syst 22:662–669

    PubMed  Article  Google Scholar 

  30. Reinprecht A, Dietrich W, Berger A, Bavinzski G, Weninger M, Czech T (2001) Posthemorrhagic hydrocephalus in preterm infants: long-term follow-up and shunt-related complications. Childs Nerv Syst 17:663–669

    PubMed  Article  CAS  Google Scholar 

  31. Sainte-Rose C, Piatt JH, Renier D et al (1991) Mechanical complication in shunts. Pediatr Neurosurg 17:2–9

    PubMed  Article  Google Scholar 

  32. Scavarda D, Bednarek A, Litre F, Koch C, Lena G, Morville P, Rousseaux P (2003) Acquired aqueductal stenosis in preterm infants: an indication for neuroendoscopic third ventriculostomy. Childs Nerv Syst 19:756–759

    PubMed  Article  CAS  Google Scholar 

  33. Sgouros S, Kulkharni AV, Constantini S (2006) The international infant hydrocephalus study: concept and rational. Childs Nerv Syst 22:338–345

    PubMed  Article  CAS  Google Scholar 

  34. Siomin V, Weiner H, Wissoff J, Cinalli G, Piere-Kahn A, Sainte-Rose C, Abbot R, Elran H, Beni-Adani L, Ouaknine G, Constatntini S (2001) Repeat endoscopic third ventriculostomy: is it worth trying? Childs Nerv Syst 17:551–555

    PubMed  Article  CAS  Google Scholar 

  35. Teo C, Rahman S, Boop FA et al (1996) Complications of endoscopic neurosurgery. Childs Nerv Syst 12:248–253

    PubMed  Article  CAS  Google Scholar 

  36. Tuli S, Alshail E, Drake J (1999) Third ventriculostomy versus cerebrospinal fluid shunt as a first procedure in pediatric hydrocephalus. Pediatr Neurosurg 30:11–15

    PubMed  Article  CAS  Google Scholar 

  37. Wagner W, Koch D (2005) Mechanism of failure after endoscopic third ventriculostomy in young infants. J Neurosurg 103:43–49

    PubMed  Google Scholar 

  38. Whitelaw A, Christie S, Pople I (1999) Transforming growth factor beta 1: a possible signal molecule for posthaemorrhagic hydrocephalus? Pediatr Res 46:576–580

    PubMed  Article  CAS  Google Scholar 

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Author information

Affiliations

  1. Department of Neurosurgery, University Hospital of Ostrava, 17. listopadu 1790, Ostrava-Poruba, 708 52, Czech Republic

    Radim Lipina & Štefan Reguli

  2. Department of Radiology, University Hospital of Ostrava, 17. listopadu 1790, Ostrava-Poruba, 708 52, Czech Republic

    Viera Doležilová

  3. Department of Pediatric Neurology, University Hospital of Ostrava, 17. listopadu 1790, Ostrava-Poruba, 708 52, Czech Republic

    Marie Kunčíková

  4. Department of Neonatology, University Hospital of Ostrava, 17. listopadu 1790, Ostrava-Poruba, 708 52, Czech Republic

    Hana Podešvová

Authors
  1. Radim Lipina
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  2. Štefan Reguli
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  3. Viera Doležilová
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  4. Marie Kunčíková
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  5. Hana Podešvová
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Correspondence to Radim Lipina.

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Lipina, R., Reguli, Š., Doležilová, V. et al. Endoscopic third ventriculostomy for obstructive hydrocephalus in children younger than 6 months of age: is it a first-choice method?. Childs Nerv Syst 24, 1021–1027 (2008). https://doi.org/10.1007/s00381-008-0616-6

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  • DOI: https://doi.org/10.1007/s00381-008-0616-6

Keywords

  • Hydrocephalus
  • Endoscopic third ventriculostomy
  • Obstructive hydrocephalus
  • Results