Skip to main content

Advertisement

SpringerLink
Log in

Endoscopic third ventriculostomy in infants of less than 1 year of age: which factors influence the outcome?

  • Original Paper
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Objectives

Endoscopic third ventriculostomy (ETV) is a successful method of treatment for obstructive hydrocephalus. In infants, however, it is reported to have a higher failure rate. On the basis of our own data and a meta-analysis of the literature, we try to define factors prognosticating potential failure in infants aged less than 1 year.

Methods

Data were collected retrospectively. Between October 1994 and October 2002, 20 ETVs were performed in 16 patients younger than 1 year. Ages ranged from 8 to 311 days (median 103). Etiology was aqueductal stenosis in all 16 patients (idiopathic in 7, posthemorrhagic in 3, postmeningitic in 3, and related to CNS or vascular malformation in 3). ETV failure was defined as subsequent need for shunt implantation. For non-shunted patients, follow up was 16–52 months (median 25).

Results

ETV was successful in 5 patients and eventually failed in 11. There was no mortality or permanent morbidity following ETV. In the successful cases, etiology was idiopathic aqueductal stenosis in 4 and postmeningitic aqueductal stenosis in 1; the median age was 206 days (range 82–311). In the 11 unsuccessful patients, it was idiopathic aqueductal stenosis in 3, posthemorrhagic in 3, postmeningitic in 2 and CNS/vascular malformation in 3 cases; median age was 94 days (range 8–299). Median time interval between (last) ETV and shunt was 38 days (range 2–70). The difference in median age between the success group and the failure group roughly corresponded to data gained from a meta-analysis of the literature. Four patients underwent a second ETV. In intraoperative ventriculoscopy, the stoma was closed or there were new membranes below the floor of the third ventricle and a second ETV was performed. But finally, all re-ETVs failed and the patients needed a shunt.

Conclusion

Factors indicating potential failure of ETV were very young age and etiology other than idiopathic aqueductal stenosis. Probability of success seems to increase during the first 2 or 3 months of life. Ventriculoscopy with the option of a second ETV should be regularly performed after failure of ETV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Mixter WJ (1923) Ventriculoscopy and puncture of the floor of the third ventricle. Preliminary report of a case. Boston Med J 188:277–278

    Google Scholar 

  2. Scarff JE (1936) Endoscopic treatment of hydrocephalus. Description of a ventriculoscope and preliminary report of cases. Arch Neurol Psychiatry 35:853–861

    Google Scholar 

  3. Sainte-Rose C (1992) Third ventriculostomy. In: Manwaring KH, Crone KR (eds) Neuroendoscopy, vol 1. Liebert, New York, pp 47–62

  4. Scarff JE (1966) Evaluation of treatment of hydrocephalus. Results of third ventriculostomy and endoscopic cauterization of choroid plexuses compared with mechanical shunts. Arch Neurol 14:382–391

    Google Scholar 

  5. Beems T, Grotenhuis JA (2002) Is the success rate of endoscopic third ventriculostomy age-dependent? An analysis of the results of endoscopic third ventriculostomy I n young children. Childs Nerv Syst 18:605–608

    Article  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  7. Hopf NJ, Grunert P, Fries G, Resch KD, Perneczky A (1999) Endoscopic third ventriculostomy: outcome analysis of 100 consecutive procedures. Neurosurgery 44:795–804

    CAS  PubMed  Google Scholar 

  8. Jones RF, Kwok BC, Stening WA, Vonau M (1996) Third ventriculostomy for hydrocephalus associated with spinal dysraphism: indications and contraindications. Eur J Pediatr Surg 6 [Suppl 1]:5–6

    PubMed  Google Scholar 

  9. Kim SK, Wang KC, Cho BK (2000) Surgical outcome of pediatric hydrocephalus treated by endoscopic III ventriculostomy: prognostic factors and interpretation of postoperative neuroimaging. Childs Nerv Syst 16:161–169

    CAS  PubMed  Google Scholar 

  10. Siomin V, Cinalli G, Grotenhuis A, Golash A, Oi S, Kothbauer K, Weiner H, Roth J, Beni-Adani L, Pierre-Kahn A, Takahashi Y, Mallucci C, Abbott R, Wisoff J, Constantini S (2002) Endoscopic third ventriculostomy in patients with cerebrospinal fluid infection and/or hemorrhage. J Neurosurg 97:519–524

    PubMed  Google Scholar 

  11. Teo C (1998) Third ventriculostomy in the treatment of hydrocephalus: experience with more then 120 cases. In: Hellwig D, Bauer BL (eds) Minimally invasive techniques for neurosurgery. Springer, Berlin Heidelberg New York, pp 73–76

  12. Guiot G, Rougerie J, Fourestier M, Fournier A, Comoy C, Vulmière J, Groux R (1963) Explorations endoscopiques intracrâniennes. Presse Med 71:1225–1228

    CAS  PubMed  Google Scholar 

  13. Guiot G (1973) Ventriculo-cisternostomy for stenosis of the aqueduct of Sylvius. Puncture of the floor of the third ventricle with a leucotome under television control. Acta Neurochir (Wien) 28:275–289

    Google Scholar 

  14. Vries JK (1978) An endoscopic technique for third ventriculostomy. Surg Neurol 9:165–168

    CAS  PubMed  Google Scholar 

  15. Abdullah J, Ariff AR, Ghazaime G, Naing NN (2001) Stereotactic neuroendoscopic management of hydrocephalus: a three-year follow-up and analysis of Malaysian children with aqueduct stenosis. Stereotact Funct Neurosurg 76:175–180

    Article  CAS  PubMed  Google Scholar 

  16. Boschert J, Neff W, Schaible T (2002) Endoskopische Ventrikulozisternostomie in frühen Kindesalter. Prakt Padiatr 8:232–240

    Google Scholar 

  17. 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  PubMed  Google Scholar 

  18. Elbabaa SK, Steinmetz M, Ross J, Moon D, Luciano MG (2001) Endoscopic third ventriculostomy for obstructive hydrocephalus in the pediatric population: evaluation of outcome. Eur J Pediatr Surg 11[Suppl 1]:S52–S54

    Article  PubMed  Google Scholar 

  19. Fritsch MJ, Mehdorn M (2002) Endoscopic intraventricular surgery for treatment of hydrocephalus and loculated CSF space in children less than one year of age. Pediatr Neurosurg 36:183–188

    Article  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  21. Javadpour M, Mallucci C, Brodbelt A, Golash A, May P (2001) The impact of endoscopic third ventriculostomy on the management of newly diagnosed hydrocephalus in infants. Pediatr Neurosurg 35:188–194

    Article  PubMed  Google Scholar 

  22. Jones RF, Stening WA, Brydon M (1990) Endoscopic third ventriculostomy. Neurosurgery 26:86–91

    CAS  PubMed  Google Scholar 

  23. Jones RF, Kwok BC, Stening WA, Vonau M (1994) The current status of endoscopic third ventriculostomy in the management of non-communicating hydrocephalus. Minim Invasive Neurosurg 37:28–36

    CAS  PubMed  Google Scholar 

  24. Kehler U, Gliemroth J (2002) Endoskopische Ventrikulozisternostomie bei Säuglingen und Kleinkindern—eine Alternative zum Shunt? Prakt Padiatr 8:244–247

    Google Scholar 

  25. Murshid WR (2000) Endoscopic third ventriculostomy: towards more indications for the treatment of non-communicating hydrocephalus. Minim Invasive Neurosurg 43:75–82

    Article  CAS  PubMed  Google Scholar 

  26. Scarrow AM, Levy EI, Pascucci L, Albright AL (2000) Outcome analysis of endoscopic III ventriculostomy. Childs Nerv Syst 16:442–445

    Article  CAS  PubMed  Google Scholar 

  27. Teo C, Jones R (1996) Management of hydrocephalus by endoscopic third ventriculostomy in patients with myelomeningocele. Pediatr Neurosurg 25:57–63

    CAS  PubMed  Google Scholar 

  28. Valenzuela S, Trellez A (1999) Pediatric neuroendoscopy in Chile. Analysis of the first 100 cases. Childs Nerv Syst 15:457–460

    Article  CAS  PubMed  Google Scholar 

  29. Brockmeyer D, Abtin K, Carey L, Walker ML (1998) Endoscopic third ventriculostomy: an outcome analysis. Pediatr Neurosurg 28:235–240

    Google Scholar 

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

    CAS  PubMed  Google Scholar 

  31. Macarthur DC, Buxton N, Vloeberghs M, Punt J (2001) The effectiveness of neuroendoscopic interventions in children with brain tumours. Childs Nerv Syst 17:589–594

    Article  CAS  PubMed  Google Scholar 

  32. Goumnerova LC, Frim DM (1997) Treatment of hydrocephalus with third ventriculocisternostomy: outcome and CSF flow patterns. Pediatr Neurosurg 27:149–152

    CAS  PubMed  Google Scholar 

  33. Kunz U, Goldmann A, Bader C, Waldbaur H, Oldenkott P (1994) Endoscopic fenestration of the 3rd ventricular floor in aqueductal stenosis. Minim Invasive Neurosurg 37:42–47

    CAS  PubMed  Google Scholar 

  34. Moorthy RK, Rajshekhar V (2002) Management of hydrocephalus associated with occipital encephalocele using endoscopic third ventriculostomy: report of two cases. Surg Neurol 57:351–355

    Article  PubMed  Google Scholar 

  35. Koch D, Grunert P, Filippi R, Hopf N (2002) Re-ventriculostomy for treatment of obstructive hydrocephalus in cases of stoma dysfunction. Minim Invasive Neurosurg 45:158–163

    Article  CAS  PubMed  Google Scholar 

  36. 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

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Section of Pediatric Neurosurgery, Department of Neurosurgery, University Hospitals, Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany

    Dorothee Koch & Wolfgang Wagner

Authors
  1. Dorothee Koch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wolfgang Wagner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dorothee Koch.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Koch, D., Wagner, W. Endoscopic third ventriculostomy in infants of less than 1 year of age: which factors influence the outcome?. Childs Nerv Syst 20, 405–411 (2004). https://doi.org/10.1007/s00381-004-0958-7

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-004-0958-7

Keywords

Search

Navigation