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Is endoscopic third ventriculostomy safe and efficient in the treatment of obstructive chronic hydrocephalus in adults? A prospective clinical and MRI study

  • Original Article - CSF Circulation
  • Published:
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Abstract

Background

In case of suspected normal pressure hydrocephalus, MRI is performed systematically and can sometimes highlight an obstruction of the flow pathways of the CSF (aqueductal stenosis or other downstream obstruction). It seems legitimate for these patients to ask the question of a treatment with endoscopic third ventriculostomy (ETV), even if the late decompensation of an obstruction may suggest an association with a CSF resorption disorder. The aim of this study was to evaluate clinical and radiological evolution after ETV in a group of elderly patients with an obstructive chronic hydrocephalus (OCH).

Methods

ETV was performed in 15 patients with OCH between 2012 and 2017. Morphometric (callosal angle, ventricular surface, third ventricular width, and Evans’ index) and velocimetric parameters (stroke volume of the aqueductal (SVa) CSF) parameters were measured prior and after surgery with brain MRI. The clinical score (mini-mental status examination (MMSE) and the modified Larsson’s score, evaluating walking, autonomy, and incontinence) were performed pre- and postoperatively.

Results

SVa was less than 15 μL/R-R in 12 out of the 15 patients; in the other three cases, the obstruction was located at a distance from the middle part of the aqueduct. Fourteen out of 15 patients were significantly improved: mean Larsson’s score decreased from 3.8 to 0.6 (P ≤ 0.01) and mean MMSE increased from 25.7 to 28 (P = 0.084). Evans’ index and ventricular area decreased postoperatively and the callosal angle increased (P ≤ 0.01). The mean follow-up lasted 17.9 months. No postoperative complications were observed.

Conclusion

ETV seems to be a safe and efficient alternative to shunt for chronic hydrocephalus with obstruction; the clinical improvement is usual and ventricular size decreases slightly.

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References

  1. Adams RD, Fisher CM, Hakim S, Ojemann RG, Sweet WH (1965) Symptomatic occult hydrocephalus with ‘normal’ cerebrospinal fluid pressure. N Engl J Med 273(3):117–126

    Article  CAS  PubMed  Google Scholar 

  2. Balédent O, Henry-Feugeas MC, Idy-Peretti I (2001) Cerebrospinal fluid dynamics and relation with blood flow: a magnetic resonance study with semiautomated cerebrospinal fluid segmentation. Investig Radiol 36(7):368–377

    Article  Google Scholar 

  3. Baroncini M, Balédent O, Ardi CE, Delannoy VD, Kuchcinski G, Duhamel A, Ares GS, Lejeune J-P, Hodel J (2018) Ventriculomegaly in the elderly: who needs a shunt? A MRI study on 90 patients. Acta Neurochir Suppl 126:221–228

    Article  PubMed  Google Scholar 

  4. Bateman GA, Levi CR, Schofield P, Wang Y, Lovett EC (2005) The pathophysiology of the aqueduct stroke volume in normal pressure hydrocephalus: can co-morbidity with other forms of dementia be excluded? Neuroradiology 47(10):741–748

    Article  PubMed  Google Scholar 

  5. Benson DF, LeMay M, Patten DH, Rubens AB (1970) Diagnosis of normal-pressure hydrocephalus. N Engl J Med 283(12):609–615

    Article  CAS  PubMed  Google Scholar 

  6. Bergsneider M, Miller C, Vespa PM, Hu X (2008) Surgical management of adult hydrocephalus. Neurosurgery 62(Suppl 2):643

    Article  PubMed  Google Scholar 

  7. Bret P, Guyotat J, Chazal J (2002) Is normal pressure hydrocephalus a valid concept in 2002? A reappraisal in five questions and proposal for a new designation of the syndrome as ‘chronic hydrocephalus’. J Neurol Neurosurg Psychiatry 73(1):9–12

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Duru S, Peiro JL, Oria M, Aydin E, Subasi C, Tuncer C, Rekate HL (2018) Successful endoscopic third ventriculostomy in children depends on age and etiology of hydrocephalus: outcome analysis in 51 pediatric patients. Child’s nervous system. ChNS 34(8):1521–1528

    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(1):5–15

    Article  PubMed  Google Scholar 

  10. El-Ghandour NMF (2011) Endoscopic third ventriculostomy versus ventriculoperitoneal shunt in the treatment of obstructive hydrocephalus due to posterior fossa tumors in children. Childs Nerv Syst 27(1):117–126

    Article  Google Scholar 

  11. Folstein MF, Folstein SE, McHugh PR (1975) ‘Mini-mental state’. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12(3):189–198

    Article  CAS  Google Scholar 

  12. Gangemi M, Mascari C, Maiuri F, Godano U, Donati P, Longatti PL (2007) Long-term outcome of endoscopic third ventriculostomy in obstructive hydrocephalus. Minim Invasive Neurosurg 50(5):265–269

    Article  CAS  PubMed  Google Scholar 

  13. González-Martínez EL, Santamarta D (2016) Does aqueductal stenosis influence the lumbar infusion test in normal-pressure hydrocephalus? Acta Neurochir 158(12):2305–2310

    Article  PubMed  Google Scholar 

  14. Guzman R, Pendharkar AV, Zerah M, Sainte-Rose C (2013) Use of the NeuroBalloon catheter for endoscopic third ventriculostomy. J Neurosurg Pediatr 11(3):302–306

    Article  PubMed  Google Scholar 

  15. Holodny AI, Waxman R, George AE, Rusinek H, Kalnin AJ, de Leon M (1998) MR differential diagnosis of normal-pressure hydrocephalus and Alzheimer disease: significance of perihippocampal fissures. AJNR Am J Neuroradiol 19(5):813–819

    CAS  PubMed  Google Scholar 

  16. Isaacs AM, Bezchlibnyk YB, Yong H, Koshy D, Urbaneja G, Hader WJ, Hamilton MG (2016) Endoscopic third ventriculostomy for treatment of adult hydrocephalus: long-term follow-up of 163 patients. Neurosurg Focus 41(3):E3

    Article  PubMed  Google Scholar 

  17. Jellinger G (1986) Anatomopathology of non-tumoral aqueductal stenosis. J Neurosurg Sci 30(1):1–16

    CAS  PubMed  Google Scholar 

  18. Kim J, Na HK, Byun J, Shin J, Kim S, Lee BH, Na DL (2017) Tracking cognitive decline in amnestic mild cognitive impairment and early-stage Alzheimer dementia: Mini-Mental State Examination versus neuropsychological battery. Dement Geriatr Cogn Disord 44(1):105–117

    Article  PubMed  Google Scholar 

  19. Kojoukhova M, Koivisto AM, Korhonen R, Remes AM, Vanninen R, Soininen H, Jääskeläinen JE, Sutela A, Leinonen V (2015) Feasibility of radiological markers in idiopathic normal pressure hydrocephalus. Acta Neurochir 157(10):1709–1719

    Article  PubMed  Google Scholar 

  20. Lacy M, Oliveira M, Austria E, Frim MD (2009) Neurocognitive outcome after endoscopic third ventriculocisterostomy in patients with obstructive hydrocephalus. J Int Neuropsychol Soc 15(3):394–398

    Article  PubMed  Google Scholar 

  21. Lapras C, Bret P, Patet JD, Huppert J, Honorato D (1986) Hydrocephalus and aqueduct stenosis. Direct surgical treatment by interventriculostomy (aqueduct canulation). J Neurosurg Sci 30(1):47–53

    CAS  PubMed  Google Scholar 

  22. Larsson A, Wikkelsö C, Bilting M, Stephensen H (1991) Clinical parameters in 74 consecutive patients shunt operated for normal pressure hydrocephalus. Acta Neurol Scand 84(6):475–482

    Article  CAS  PubMed  Google Scholar 

  23. Locatelli M, Draghi R, DI Cristofori A, Carrabba G, Zavanone M, Pluderi M, Spagnoli D, Rampini P (2014) Third ventriculostomy in late-onset idiopathic aqueductal stenosis treatment: a focus on clinical presentation and radiological diagnosis. Neurol Med Chir 54(12):1014–1021

    Article  Google Scholar 

  24. Oi S, Shimoda M, Shibata M, Honda Y, Togo K, Shinoda M, Tsugane R, Sato O (2000) Pathophysiology of long-standing overt ventriculomegaly in adults. J Neurosurg 92(6):933–940

    Article  CAS  PubMed  Google Scholar 

  25. Sankey EW, Jusue-Torres I, Elder BD, Goodwin CR, Batra S, Hoffberger J, Lu J, Blitz AM, Rigamonti D (2015) Functional gait outcomes for idiopathic normal pressure hydrocephalus after primary endoscopic third ventriculostomy. J Clin Neurosci 22(8):1303–1308

    Article  PubMed  Google Scholar 

  26. Tisell M, Almström O, Stephensen H, Tullberg M, Wikkelsö C (2000) How effective is endoscopic third ventriculostomy in treating adult hydrocephalus caused by primary aqueductal stenosis? Neurosurgery 46(1):104

    Article  CAS  PubMed  Google Scholar 

  27. Tudor KI, Tudor M, McCleery J, Car J (2015) Endoscopic third ventriculostomy (ETV) for idiopathic normal pressure hydrocephalus (iNPH). Cochrane Database Syst Rev 7:CD010033

    Google Scholar 

  28. Vulcu S, Eickele L, Cinalli G, Wagner W, Oertel J (2015) Long-term results of endoscopic third ventriculostomy: an outcome analysis. J Neurosurg 123(6):1456–1462

    Article  PubMed  Google Scholar 

  29. Woodworth G, McGirt MJ, Thomas G, Williams MA, Rigamonti D (2007) Prior CSF shunting increases the risk of endoscopic third ventriculostomy failure in the treatment of obstructive hydrocephalus in adults. Neurol Res 29(1):27–31

    Article  PubMed  Google Scholar 

  30. Woodworth GF, See A, Bettegowda C, Batra S, Jallo GI, Rigamonti D (2012) Predictors of surgery-free outcome in adult endoscopic third ventriculostomy. World Neurosurgery 78(3):312–317

    Article  PubMed  Google Scholar 

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Acknowledgements

We thank Ingrid Bouvier, for proofreading the document in English.

Funding

This study received financial support in the form of the interregional clinical research hospital program (IR11) funding.

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Authors and Affiliations

  1. Department of Neurosurgery, Lille University Hospital (CHU Lille), University of Lille, Rue Emile Laine, Lille, France

    Marc Baroncini, Philippe Bourgeois & Henri Arthur Leroy

  2. Department of Neuroradiology, Lille University Hospital (CHU Lille), University of Lille, Lille, France

    Gregory Kuchcinski & Vianney Le Thuc

  3. Department of Neurology, Lille University Hospital (CHU Lille), University of Lille, Lille, France

    Guillaume Baille, Thibaud Lebouvier & Luc Defebvre

Authors
  1. Marc Baroncini
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  2. Gregory Kuchcinski
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  3. Vianney Le Thuc
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  4. Philippe Bourgeois
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  5. Henri Arthur Leroy
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  6. Guillaume Baille
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Correspondence to Marc Baroncini.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (ethics committee of the Amiens University Hospital where the full study protocol can be accessed: n° ID RCB: 2011-A01633-38) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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This article is part of the Topical Collection on CSF Circulation

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Baroncini, M., Kuchcinski, G., Le Thuc, V. et al. Is endoscopic third ventriculostomy safe and efficient in the treatment of obstructive chronic hydrocephalus in adults? A prospective clinical and MRI study. Acta Neurochir 161, 1353–1360 (2019). https://doi.org/10.1007/s00701-019-03932-2

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  • DOI: https://doi.org/10.1007/s00701-019-03932-2

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