O'Brien DF, Javadpour M, Collins DR, Spennato P, Mallucci CL. (2005) Endoscopic third ventriculostomy: an outcome analysis of primary cases and procedures performed after ventriculoperitoneal shunt malfunction. Journal of Neurosurgery. 2005 Nov;103(5 Suppl):393-400.
Department of Neurosurgery, Royal Liverpool Children's Hospital NHS Trust, Liverpool, United Kingdom.
OBJECT: The authors analyzed the role of endoscopic third ventriculostomy (ETV) as a primary treatment for hydrocephalus and also as an alternative to shunt revision for malfunctioning and infected ventriculoperitoneal (VP) shunts.
METHODS: A retrospective analysis of clinical notes, operation records, and magnetic resonance imaging procedures before and after ventriculostomy was performed to determine the success or failure of ETVs in 170 patients who underwent a primary ETV and in 63 patients who underwent an ETV for shunt malfunction (secondary ETV). The patients' data were derived from an endoscopy database inaugurated in 1998. Of the 63 patients with shunt malfunctions, 49 patients (78%) had mechanical malfunction only and 14 patients (22%) had both infection and malfunction. Seventy-four percent (126 of 170) of patients in the primary ETV group and 70% (44 of 63) of patients in the secondary ETV had a successful outcome at the time of analysis. The success rate for ETVs in cases involving a mechanical shunt malfunction alone was 67% (33 of 49) compared with 79% (11 of 14) in those cases involving an infected shunt. The origin of the hydrocephalus in the primary and shunt malfunction groups was evaluated as a factor contributing to the success of the ETV. In the primary group, patients with a history of intraventricular hemorrhage (IVH) and meningitis as a cause for hydrocephalus had a poor rate of success after the ETV--27% (four of 15) and 0% (none of two), respectively. This pattern was not seen in the series involving shunt malfunction after the ETV, with 71% (five of seven) and 75% (three of four) of cases having a hydrocephalus origin of IVH and meningitis, respectively, in which a successful outcome was attained. A two-way mixed-model analysis of variance yielded a significant effect for origin (p = 0.011), a significant interaction between group and origin (p = 0.028), and a marginally nonsignificant effect of group (p = 0.0686). More than 95% of failures were evident within 1 month of the ETV in both groups. Complications were minimal in both groups, and there were no procedure-related deaths.
CONCLUSIONS: An ETV is a safe procedure with few complications and a high success rate in both primary and secondary groups. An ETV to address shunt malfunction, unlike a primary ETV, is not particularly origin specific. A bonus is its success in dealing with infected shunts. Most failures will be evident early, but long-term follow up is vital.
PMID: 16302610
Showing posts with label Endoscope-assisted. Show all posts
Showing posts with label Endoscope-assisted. Show all posts
Monday, June 29, 2009
Endoscopic third ventriculostomy for malfunction in previously shunted infants.
Bilginer B, Oguz KK, Akalan N. (2009) Endoscopic third ventriculostomy for malfunction in previously shunted infants. Child's Nervous System. Jun;25(6):683-8.
Department of Neurosurgery, Hacettepe University School of Medicine, Ankara, Turkey. burcak@tr.net
INTRODUCTION: The usage of endoscopic third ventriculostomy (ETV) as an alternative to shunt revision in the management of shunt malfunction is gaining popularity. METHODS: We review the clinical data of 45 patients who underwent ETV because of ventriculopritoneal shunt malfunction at Hacettepe University School of Medicine Department of Neurosurgery between January 2002 and August 2007. Medical records of the patients were retrospectively studied.
RESULTS: Male-to-female ratio was 23/22. The cause of the hydrocephalus was aqueduct stenosis in 21 (46.9%) patients, newborn meningitis in nine (20%) patients, tumor in six (13.3%) patients, newborn intraventricular hemorrhage in four (8.8%) patients, myelomeningocele in three (6.6%), and trauma in two (2.2%) patients. Of the patients, 27 (60%) had triventricular and 18 (40%) had tetraventricular hydrocephalus at their radiologic evaluation. On admission, all patients had at least one episode of shunt dysfunction prior to ETV. Follow-up duration after surgery was 1-5 years (mean 2.46 +/- 1.64 years). Postoperative cerebrospinal fluid flow studies using the cine-PC MR imaging were performed on all patients. The overall success rate for ETV after shunt malfunction was 80% with 36 patients and failure rate was 20% with nine patients. All of these nine patients had undergone shunt insertion within 10 days-1 month after unsuccessful ETV.
CONCLUSION: Endoscopic third ventriculostomy is an effective treatment for shunt malfunction.
PMID: 19082608
Department of Neurosurgery, Hacettepe University School of Medicine, Ankara, Turkey. burcak@tr.net
INTRODUCTION: The usage of endoscopic third ventriculostomy (ETV) as an alternative to shunt revision in the management of shunt malfunction is gaining popularity. METHODS: We review the clinical data of 45 patients who underwent ETV because of ventriculopritoneal shunt malfunction at Hacettepe University School of Medicine Department of Neurosurgery between January 2002 and August 2007. Medical records of the patients were retrospectively studied.
RESULTS: Male-to-female ratio was 23/22. The cause of the hydrocephalus was aqueduct stenosis in 21 (46.9%) patients, newborn meningitis in nine (20%) patients, tumor in six (13.3%) patients, newborn intraventricular hemorrhage in four (8.8%) patients, myelomeningocele in three (6.6%), and trauma in two (2.2%) patients. Of the patients, 27 (60%) had triventricular and 18 (40%) had tetraventricular hydrocephalus at their radiologic evaluation. On admission, all patients had at least one episode of shunt dysfunction prior to ETV. Follow-up duration after surgery was 1-5 years (mean 2.46 +/- 1.64 years). Postoperative cerebrospinal fluid flow studies using the cine-PC MR imaging were performed on all patients. The overall success rate for ETV after shunt malfunction was 80% with 36 patients and failure rate was 20% with nine patients. All of these nine patients had undergone shunt insertion within 10 days-1 month after unsuccessful ETV.
CONCLUSION: Endoscopic third ventriculostomy is an effective treatment for shunt malfunction.
PMID: 19082608
Tuesday, July 24, 2007
Endovascular placement of a ventriculoatrial shunt. Technical note.
Gonzalez LF, Kim L, Rekate HL, McDougall CG, Albuquerque FC. Endovascular placement of a ventriculoatrial shunt. Technical note. Technical note. Journal of Neurosurgery. 2007 Apr;106(4 Suppl):319-21.
Atrial shunt revision surgeries are sometimes difficult due to venous occlusion and neck scarring. A direct approach guided by venography facilitates exposure and guarantees accurate placement of the distal catheter. Five patients with complicated histories of shunt malfunction were treated using an endoscope-assisted technique. The distal end of an atrial catheter was advanced into the atrium after having been connected to a venous catheter of a slightly smaller diameter than the one previously advanced from the femoral vein through the atrium. Once the position of the atrial catheter was confirmed fluoroscopically, the venous catheter was detached and removed. No complications developed in any patient. This endoscope-assisted technique offers three advantages: it demonstrates the patency of the jugular vein through venography, facilitates identification of the internal jugular vein in the neck, and provides a quick way to confirm that the distal end of the atrial catheter has been placed correctly. This technique should be considered for use in patients with a history of failed atrial shunts.
PMID: 17465370
Atrial shunt revision surgeries are sometimes difficult due to venous occlusion and neck scarring. A direct approach guided by venography facilitates exposure and guarantees accurate placement of the distal catheter. Five patients with complicated histories of shunt malfunction were treated using an endoscope-assisted technique. The distal end of an atrial catheter was advanced into the atrium after having been connected to a venous catheter of a slightly smaller diameter than the one previously advanced from the femoral vein through the atrium. Once the position of the atrial catheter was confirmed fluoroscopically, the venous catheter was detached and removed. No complications developed in any patient. This endoscope-assisted technique offers three advantages: it demonstrates the patency of the jugular vein through venography, facilitates identification of the internal jugular vein in the neck, and provides a quick way to confirm that the distal end of the atrial catheter has been placed correctly. This technique should be considered for use in patients with a history of failed atrial shunts.
PMID: 17465370
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