Endoscopic Third Ventriculostomy in Previously Shunted Children

Czech version

Authors: R. Lipina ^1,2; T. Hrbáč ¹; M. Chlachula ¹; T. Krejčí ¹; M. Kunčíková ³
Authors‘ workplace: Neurochirurgická klinika FN Ostrava ¹; LF UK v Hradci Králové ²; Klinika dětské neurologie FN Ostrava ³
Published in: Cesk Slov Neurol N 2013; 76/109(2): 207-210
Category: Short Communication

Overview

Aim:
Endoscopic third ventriculostomy (ETV) is a routine and safe procedure for treatment of obstructive hydrocephalus. The aim of our study was to evaluate EVS success rate in treating obstructive hydrocephalus in paediatric patients with former ventriculo-peritoneal (V-P) shunt implantation.

Material and methods:
We performed ETV in 36 patients with former V-P drainage implantation between 2001 and October 2011. Pre-surgical brain MRI performed in all patients confirmed an obstruction in aqueduct or outflow parts of the fourth ventricle. During the surgery, the V-P shunt was clipped and ETV was performed. In patients with favourable clinical condition and functional stoma on MR, the V-P shunt was removed 3 months after the ETV. In indicated patients, the Ommaya reservoir was inserted to enable emergency cerebrospinal fluid tapping.

Results:
Our group of 36 patients involved 11 patients with congenital aqueduct stenosis, 14 patients with posthemorrhagic hydrocephalus, 6 patients with post-infection hydrocephalus and 5 patients with Chiari malformation – associated hydrocephalus. Nine patients underwent unsuccessful ETV in infancy. Patients in whom V-P shunt could be removed three month after the ETV were evaluated as successful; 26 patients (72%) in our group were successful. There was one serious complication in the group – one patient died 2.5 years after the surgery due to delayed ETV failure.

Conclusion:
The ETV is a method of choice in obstructive hydrocephalus even in patients with former V-P shunt implantation. MR is feasible in acute or scheduled V-P shunt surgical revision. Hydrocephalus may be solved endoscopically in patients with confirmed obstruction in the ventricular system.

Key words:
endoscopy – ventriculocisternostomy – hydrocephalus – ventriculo-peritoneal shunt

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