J Korean Neurosurg Soc.  2017 May;60(3):306-314. 10.3340/jkns.2017.0202.013.

Endoscopic Third Ventriculostomy: Success and Failure

• Deopujari
• Karmarkar
• Shaikh ST

• KMID: 2382765
• DOI: http://doi.org/10.3340/jkns.2017.0202.013

Abstract

Endoscopic third ventriculostomy (ETV) has now become an accepted mode of hydrocephalus treatment in children. Varying degrees of success for the procedure have been reported depending on the type and etiology of hydrocephalus, age of the patient and certain technical parameters. Review of these factors for predictability of success, complications and validation of success score is presented.

Keyword

Hydrocephalus; Ventriculostomy; Cerebrospinal fluid shunt

MeSH Terms

Cerebrospinal Fluid Shunts
Child
Humans
Hydrocephalus
Ventriculostomy*

Figure

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  Fig. 1 An ideal candidate for ETV at six and half months of age due to congenital aqueduct stenosis with dilated third ventricle, floor bulging down into the interpeduncular cistern and adequate pre-pontine space. ETV: endoscopic third ventriculostomy.

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  Fig. 2 CSF flow across the stoma post ETV seen in cine flow MRI sequence for evaluation of ETV success. CSF: cerebrospinal fluid, MRI: magnetic resonance imaging, ETV: endoscopic third ventriculostomy.

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  Fig. 3 A: Primary ETV failure in a child with post tuberculous meningitic hydrocephalus presenting with acute deterioration in emergency. B: Stenosed stoma with scar in the floor of the third ventricle (arrow) during secondary ETV. C: MR image showing restoration of CSF flow across the stoma (arrows) post secondary ETV. Patient has not needed any further procedure in eleven years of follow-up with a good intellectual outcome. ETV: endoscopic third ventriculostomy, MR: magnetic resonance, CSF: cerebrospinal fluid, CT: computed tomography.

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  Fig. 4 A: Post shunting brain CT images showing unilateral and asymmetrical drainage of CSF. B: Post endoscopic septostomy brain CT images showing resolution. CSF: cerebrospinal fluid, CT: computed tomography.

Reference

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