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Neurosurgical Techniques and Strategies
Published in David A. Walker, Giorgio Perilongo, Roger E. Taylor, Ian F. Pollack, Brain and Spinal Tumors of Childhood, 2020
Jonathan E. Martin, Ian F. Pollack, Robert F. Keating
Endoscopic third ventriculostomy is the most broadly utilized technique for patients with obstructive hydrocephalus. Individuals with non-obstructive hydrocephalus (i.e., blood, infection, tumor metastases) do not benefit from an endoscopic third ventriculostomy. The procedure involves creating a fenestration in the floor of the third ventricle (Figure 6.3), bypassing obstructions to spinal fluid flow at the level of the cerebral aqueduct and/or fourth ventricle.22 The fenestration is most commonly created with a blunt instrument or endoscope, with some dilating the hole created with a 3 French balloon. The procedure allows for the preservation of normal physiologic spinal fluid absorption at the level of arachnoid granulations, and avoids indwelling hardware with its attendant risk of mechanical and infectious complications. Complications of this technique are rare, but potentially serious, and include basilar artery injury/stroke, direct brainstem injury, neurocognitive impairment due to forniceal injury, and transient neuroendocrine dysfunction. Success rates as high as 80–90% in the patient with obstructive hydrocephalus have been reported. The potential for further improvement in procedural success with the addition of choroid plexus cauterization23 has yet to be determined in the neuro-oncology patient population.
Hydrocephalus
Published in Michael Y. Wang, Andrea L. Strayer, Odette A. Harris, Cathy M. Rosenberg, Praveen V. Mummaneni, Handbook of Neurosurgery, Neurology, and Spinal Medicine for Nurses and Advanced Practice Health Professionals, 2017
Nadine Bradley, Jimmi Amick, Brandon G. Rocque
An alternative to shunting is endoscopic third ventriculostomy (ETV). This procedure is particularly well suited to treatment of hydrocephalus due to obstruction of CSF pathways within the ventricles or at the outlet of the fourth ventricle (e.g., aqueductal stenosis or posterior fossa tumor). The procedure involves introduction of an endoscope into the lateral ventricle, navigation of the endoscope through the foramen of Monro, and creation of an ostomy in the floor of the third ventricle. The ETV Success Score (ETVSS) is a model designed to predict the probability of successful ETV based on preoperative factors (Kulkarni et al., 2010) (Table 35.1).
Hydrocephalus
Published in Prem Puri, Newborn Surgery, 2017
Jothy Kandasamy, Maggie K. Lee, Mark A. Hughes, Conor L. Mallucci
The estimated prevalence of congenital and infantile hydrocephalus is between 0.5 and 0.8 per 1000 births (live and still).1–3 Until the advent of viable shunts (over 60 years ago), hydrocephalus was usually fatal. The mainstay of treatment of hydrocephalus in the infant remains CSF diversion with shunting. However, neuroendoscopic procedures (predominantly endoscopic third ventriculostomy [ETV]) are increasingly utilized in certain situations. Technological advances in neuroimaging, neuronavigation, and shunt hardware, and a better understanding of CSF dynamics is leading to a more patient-specific approach to this complex and multifactorial problem. Hydrocephalus may cause pathological changes to brain morphology, microstructure, circulation, biochemistry, metabolism, and maturation. Although treatment does not always reverse the damage, the timing of therapy is crucial in determining reversibility and outcome for the patient.
The clinicopathological profile and value of multidisciplinary management of pediatric brain tumors in a low-income setting
Published in Pediatric Hematology and Oncology, 2023
Richard Nyeko, Joyce Balagadde Kambugu, Racheal Angom, Hussein Senyonjo, Solomon Kibudde, Fadhil Geriga, Jaques van Heerden
Only over a quarter (n = 10, 28.5%) of the children underwent surgical resection, of which 6 (17.1%) were gross total resections (GTR) and 4 (11.4%) were subtotal resections (STR). Seven (77.8%) of the children with craniopharyngioma had a cyst decompression procedure. Cerebrospinal fluid (CSF) diversion procedures to relieve intracranial pressure were performed in 15 (42.9%) of the cases, of which seven (20.0%) were ventriculoperitoneal shunts (VPS) and eight (22.9%) were endoscopic third ventriculostomy/external ventricular drain (ETV/EVD). A total of 10 (28.6%) of the children received chemotherapy, 6 (17.1%) received radiotherapy and 7 (20.0%) palliative treatment as part of multimodal therapy. As expected, multimodality treatment was also a common practice as shown in Table 4.
Tetraventricular hydrocephalus with aqueductal flow void: an overlooked entity having consistent improvement following endoscopic third ventriculostomy
Published in British Journal of Neurosurgery, 2023
Sushanta K. Sahoo, Sivashanmugam Dhandapani, Chirag K. Ahuja
Tetraventricular hydrocephalus (TetHCP) is a heterogeneous group of disorders having cerebrospinal fluid (CSF) flow resistance at either the fourth ventricular outlets or the arachnoid granulations. Most of the reported cases of TetHCP presenting with intracranial hypertension are secondary to meningitis, hemorrhage or congenital, while TetHCP without overt intracranial hypertension constitutes a separate entity of ‘Normal Pressure Hydrocephalus (NPH). The primary idiopathic type of TetHCP presenting with intracranial hypertension is relatively uncommon. Endoscopic third ventriculostomy (ETV) has been reported in these cases considering their obstructive etiology with varying success rates.1,2 Though CSF flow voids on sagittal magnetic resonance imaging (MRI) suggestive of hyperdynamic flow pattern have been studied in NPH and other CSF pathophysiology, there are no reports of hyperdynamic CSF flow among patients of primary TetHCP with intracranial hypertension.3,4 In this paper, we report on the efficacy and rationale of ETV in a specific subset of primary TetHCP with aqueductal CSF flow voids.
Feasibility of awake endoscopic third ventriculostomy in selected patients of obstructive hydrocephalus
Published in British Journal of Neurosurgery, 2023
Sushant K. Sahoo, Pravin Salunke, Sivashanmugam Dhandapani, Anshul Siroliya, Kiran Jangra
Endoscopic third ventriculostomy (ETV) has mostly replaced the shunt surgery for hydrocephalus (HCP) with excellent long term outcomes.1 Usually, these surgeries are performed under general anesthesia (GA) which allows the surgeon to maneuver the endoscope safely in the ventricular system. However, some patients may not be good candidates for GA. The safety and efficacy of specific neurosurgical procedures performed under local anesthesia (LA) and sedation are well established.2 Performing ETV under LA although known but is less standardized and not in regular practice.3 In this study, we have analyzed our patients who underwent ETV under local anesthesia. The indications and advantages of ETV performed under LA are discussed and the nuances further highlighted.