Skip to main content

A retrospective analysis of revision endoscopic third ventriculostomy

Child's Nervous System volume 26, pages 1693–1698 (2010)Cite this article

Abstract

Purpose

Endoscopic third ventriculostomy (ETV) has gained favour as an effective treatment for obstructive hydrocephalus. However, the timing of ETV failure and the long-term efficacy of revision ETV remain poorly documented.

Methods

A retrospective review was performed of patients undergoing revision ETV between 1999 and 2007. Only those patients in whom there was evidence of a good sustained clinical improvement after the initial ETV were considered candidates for ETV revision. All other patients underwent insertion of a ventriculoperitoneal shunt at the time of ETV failure. Failures that were selected for repeat ETV were subdivided into; “early” if the revision occurred within the first 3 months of the primary procedure and “late” if occurring after this.

Results

Ten patients underwent revision ETV (6% of all ETVs performed). Age ranged from 2 months to 32 years (mean 13.6 years). Three “early” revision ETV were performed at a mean of 1.3 months, and there were seven “late” revisions performed at a mean of 27 months. The stoma was closed in seven patients and narrowed in one patient, and a second membrane was found under the original patent stoma in a further two patients. In two patients, a third ETV procedure was performed (both at 1 month after second ETV), and the stoma was closed in both these patients. No patients have required a shunt.

Conclusion

At last follow-up (mean 38 months), all patients remain well. Revision ETV appears a safe and effective means of managing hydrocephalus—providing there is clinical evidence that the primary procedure was initially effective. It is important to emphasise that patients with an initially successful ETV are by no means “cured”.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

References

  1. Cinalli G, Sainte-Rose C, Chumas P, Zerah M, Brunelle F, Lot G, Pierre-Kahn A, Renier D (1999) Failure of third ventriculostomy in the treatment of aqueductal stenosis in children. J Neurosurg 90:448–454

    CAS  Article  PubMed  Google Scholar 

  2. 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 Neurosurgery (pediatrics) 105:118–126

    Article  Google Scholar 

  3. Peretta P, Cinalli G, Spennato P, Ragazzi P, Ruggiero C, Aliberti F, Carlino C, Cianciulli E (2009) Long-term results of a second endoscopic third ventriculostomy in children: retrospective analysis of 40 cases. Neurosurgery 65(3):539–547

    Article  PubMed  Google Scholar 

  4. Tyagi A, Chumas P, Ferrie C (2001) Obstructive hydrocephalus following herpes simplex virus type 1 encephalitis treated by repeated third ventriculostomy. Pediatr Neurosurg 34(5):225–280

    Article  Google Scholar 

  5. Thomson S, Tyagi AK, Chumas PD (2003) Intracranial hypertrophic calcification complicating neuroendoscopy. Report of three cases. J Neurosurg 98(1):186–189

    Article  PubMed  Google Scholar 

  6. Fukuhara T, Luciano M, Kowalski RJ (2002) Clinical features of third ventriculostomy failures classified by fenestration patency. Surg Neurol 58:102–110

    Article  PubMed  Google Scholar 

  7. Natelson SE (1981) Early third ventriculostomy in meningomyelocele infants—shunt independence? Childs Brain 8:321–325

    CAS  PubMed  Google Scholar 

  8. Sayers MP, Kosnick EJ (1976) Percutaneous third ventriculostomy: experience and technique. Childs Brain 2:24–30

    CAS  PubMed  Google Scholar 

  9. Dusick JR, McArthur DL, Bergsneider M (2008) Success and complication rates of endoscopic third ventriculostomy for adult hydrocephalus: a series of 108 patients. Surg Neurol 69:5–15

    Article  PubMed  Google Scholar 

  10. Kulkarni AV, Drake JM, Armstrong DC, Dirks PB (2000) Imaging correlates of successful endoscopic third ventriculostomy. J Neurosurg 92(6):915–919

    CAS  Article  PubMed  Google Scholar 

  11. Wagner W, Koch D (2005) Mechanisms of failure after third ventriculostomy in young infants. J Neurosurgery (Pediatrics) 103(1):43–49

    Article  Google Scholar 

  12. Mohanty A, Vasudev MK, Sampath S, Radhesh S, Sastry Kolluri VR (2002) Failed endoscopic third ventriculostomy in children: management options. Pediatr Neurosurg 37:304–309

    Article  PubMed  Google Scholar 

  13. Grotenhuis JA (2000) Repeat endoscopic third ventriculostomy: is it useful? Endoscopic third ventriculostomy in the treatment of hydrocephalus. An analysis of indications, techniques and results. pp 195–199

  14. Koch D, Wagner W (2004) Endoscopic third ventriculostomy in infants of less than 1 year of age: which factors influence the outcome? Childs Nerv Syst 20(6):405–411

    Article  PubMed  Google Scholar 

  15. Siomin V, Weiner H, Wisoff J, Cinalli G, Pierre-Kahn A, Saint-Rose A, Abbott R, Elran H, Beni-Adani L, Ouaknine G, Constantini S (2001) Repeat endoscopic third ventriculostomy: is it worth trying? Childs Nerv Syst 17:551–555

    CAS  Article  PubMed  Google Scholar 

  16. 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

    CAS  Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Affiliations

  1. Department of Neurosurgery, The General Infirmary at Leeds, Great George Street, Leeds, West Yorkshire, LS1 3EX, UK

    Surash Surash, Paul Chumas, Deepti Bhargava, Darach Crimmins & Atul Tyagi

  2. Department of Neuroradiology, The General Infirmary at Leeds, Great George Street, Leeds, West Yorkshire, LS1 3EX, UK

    John Straiton

Authors
  1. Surash Surash
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Paul Chumas
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Deepti Bhargava
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Darach Crimmins
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. John Straiton
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Atul Tyagi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Paul Chumas.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Surash, S., Chumas, P., Bhargava, D. et al. A retrospective analysis of revision endoscopic third ventriculostomy. Childs Nerv Syst 26, 1693–1698 (2010). https://doi.org/10.1007/s00381-010-1176-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-010-1176-0

Keywords

  • Hydrocephalus
  • Endoscopic third ventriculostomy
  • Shunts
  • Shunt revisions