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Stented endoscopic third ventriculostomy—indications and results

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Abstract

Objective

In patients with risk of reclosure of a performed opening in the floor of the third ventricle, a stented endoscopic third ventriculostomy (sETV) was performed to maintain continuous cerebrospinal fluid (CSF) diversion in patients with occlusive hydrocephalus. A retrospective analysis of a patient series is presented.

Methods

A cohort of nine patients (median age 12 years and 9 months; range 1 month to 25 years and 9 months) was studied retrospectively. Etiology of hydrocephalus was aqueduct stenosis due to tumorous occlusion and tumorous infiltration of the third ventricular floor in seven of nine patients. For two patients with simple aqueductal stenosis, a sETV was performed because of young age of 1 month in one and because of previous ETV failure in the other.

Results

Correct placement of the implanted stent was demonstrated in all treated patients. There was no operative morbidity after the performed sETV. Resolution or improvement of symptoms was achieved in eight of nine patients (88.9 %), and failure to control clinical symptoms was observed in one patient (11.1 %), who needed subsequent shunt insertion. Decreased ventricular dimensions were seen after the sETV procedure. The median fronto-occipital horn ratio (FOHR) decreased from 0.46 (range 0.43–0.58) to 0.45 (range 0.37 to 0.59) after a median of 3 months and to a median of 0.40 (range 0.30 to 0.50) after 17 months. The median fronto-occipital horn width ratio FOHWR decreased from 0.31 (range 0.22 to 0.52) to 0.28 (range 0.14 to 0.52, p = 0.06) after a median of 3 months and to a median of 0.21 (range 0.09 to 0.36, p < 0.05).

Conclusion

sETV is a feasible and safe alternative procedure which when performed with an appropriate trajectory allows treatment of occlusive hydrocephalus with altered anatomy of the third ventricular floor. sETV has been demonstrated to resolve or improve clinical and radiological signs of disturbed CSF circulation.

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Conflict of interest

UWT and MS receives travel and/ or lecture funds from Aesculap company. BS has no conflict of interest.

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Authors and Affiliations

  1. Division of Pediatric Neurosurgery, Charité Universitätsmedizin, Berlin, Germany

    Matthias Schulz & Ulrich-Wilhelm Thomale

  2. Department of Pediatric Radiology, Charité Universtätsmedizin, Berlin, Germany

    Birgit Spors

  3. Arbeitsbereich Pädiatrische Neurochirurgie, Charité Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, D-13353, Berlin, Germany

    Ulrich-Wilhelm Thomale

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  1. Matthias Schulz
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Correspondence to Ulrich-Wilhelm Thomale.

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Schulz, M., Spors, B. & Thomale, UW. Stented endoscopic third ventriculostomy—indications and results. Childs Nerv Syst 31, 1499–1507 (2015). https://doi.org/10.1007/s00381-015-2787-2

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  • DOI: https://doi.org/10.1007/s00381-015-2787-2

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