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CC BY-NC-ND 4.0 · Asian J Neurosurg 2020; 15(04): 926-930
DOI: 10.4103/ajns.AJNS_161_20
Original Article

Endoscopic third ventriculostomy: Role of image guidance in reducing the complications

Muhammad Wasi
Department of Neurosurgery, Hull Royal Infirmary, Hull
,
Salman Sharif
1   Department of Neurosurgery, Liaquat National Hospital, Karachi
,
Yousuf Shaikh
1   Department of Neurosurgery, Liaquat National Hospital, Karachi
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Introduction: Endoscopic third ventriculostomy (ETV) is performed by neurosurgeons around the world for the management of hydrocephalus. ETV has been associated with multiple complications, the most significant being iatrogenic injury to the fornix. We aim to establish the fact that the use of image guidance while planning a trajectory can reduce the incidence of complications as it significantly alters the usual approach for ETV, i.e., the coronal burr hole can be useful for young neurosurgeons to overcome the learning curve associated with the procedure. Materials and Methods: This is a prospective, observational study conducted at Liaquat National Hospital. In this study, 43 patients were included who underwent ETV for hydrocephalus. Complications were divided into three major groups: arterial hemorrhage, venous hemorrhage, and injury to neural structures (fornix, hypothalamus, and oculomotor nerve). The data were compared with studies showing the complications of ETV with and without usage of image guidance. Results: Among the 43 patients who underwent ETV with image guidance, only two patients (4.65%) had iatrogenic fornix contusions. Neither of them developed memory impairment. None of the patients (0%) encountered other major iatrogenic complications, including injury to the mammillary body, basilar artery, or oculomotor nerve. Conclusion: The use of image guidance can reduce trajectory-related complications, including hemorrhage and iatrogenic injuries to the fornix. This study showed that the altered trajectory was beneficial in avoiding major neurological structures while introducing an endoscope through the cortex into the ventricular system.

Key-words:

Cerebrospinal fluid diversion - endoscopic third ventriculostomy - endoscopic third ventriculostomy complications - fornix injury - hydrocephalus - image guidance

Financial support and sponsorship

Nil.




Publication History

Received: 16 April 2020

Accepted: 21 June 2020

Article published online:
16 August 2022

© 2020. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Rasul FT, Marcus HJ, Toma AK. Is endoscopic third ventriculostomy superior to shuntsin patients with non-communicating hydrocephalus? A systematic review and meta-analysis of the evidence. Acta Neurochir 2013;155:883-9.
  • 2 Mixter W. Ventriculoscopy and puncture of the floor of the third ventricle. Boston Med Surg J 1923;188:277-8.
  • 3 Di Vincenzo J, Keiner D, Gaab MR, Schroeder HW, Oertel JM. Endoscopic thirdventriculostomy: Preoperative Considerations and intraoperative Strategy based on 300 procedures. J Neurol Surg 2014;75:20-30.
  • 4 Feng H, Huang G, Liao X. Endoscopic third ventriculostomy in the management of obstructive hydrocephalus: An outcome analysis. J Neurosurg 2004;100:626-33.
  • 5 Fritsch MJ, Kienke S, Ankermann T, Padoin M, Mehdorn HM. Endoscopic thirdventriculostomy in infants. J Neurosurg 2005;103:50-3.
  • 6 Spennato P, Tazi S, Bekaert O. Endoscopic third ventriculostomy for idiopathic aqueductal stenosis. World Neurosurg 2013;79:13-20
  • 7 Bouras T, Sgouros S. Complications of endoscopic third ventriculostomy. World Neurosurg 2013;79:9-12.
  • 8 Folstein MF, Folstein SE, McHugh PR. Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-98.
  • 9 Cinalli G. Endoscopic third ventriculostomy. In: Cinalli G, Maixner WJ, Sainte-Rose C, editors. Pediatric Hydrocephalus. Italia: Springer-Verlag; 2004. p. 361-88.
  • 10 Kulkarni AV, Drake JM, Kestle JR. Predicting who will benefit from endoscopic third ventriculostomy compared with shunt insertion in childhood hydrocephalus using the ETV Success Score. J Neurosurg Pediatr 2010;6:310-5.
  • 11 Breimer GE, Sival DA, Brusse-Keizer MG. An external validation of the ETVSS for both short-term and long-term predictive adequacy in 104 pediatric patients. Childs Nerv Syst 2013;29:1305-11.
  • 12 Durnford AJ, Kirkham FJ, Mathad N. Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus: Validation of a success score that predicts long-term outcome. J Neurosurg Pediatr 2011;8:489-93.
  • 13 Matthew GS, Zakaria R, Ellenbogen JR. Long-term follow-up of endoscopic third ventriculostomy performed in the pediatric population. J Neurosurg Pediatr 2016;17:734-8.
  • 14 Hoffman HJ, Harwood-Nash D, Gilday DL. Percutaneous third ventriculostomy in the management of non-communicating hydrocephalus. Neurosurgery 1980;7:313-21.
  • 15 Kelly PJ, Goerss S, Kall BA, Kispert DB. Computer tomography based stereotactic thirdventriculostomy: Technical note. Neurosurgery 1986;18:791-4.
  • 16 Kelly PJ. Stereotactic third ventriculostomy in patients with nontumoral adolescent/adult onset aqueductal stenosis and symptomatic hydrocephalus. J Neurosurg 1991;75:865-73.
  • 17 Aref M, Martyniuk A, Nath S, Koziarz A, Badhiwala J, Algird A, et al. Endoscopic third ventriculostomy: Outcome analysis of an anterior entry point. World Neurosurg 2017;104:554-9.
  • 18 Baykan N, Isbir O, Gerçek A, Dağnar A, Ozek M.M (2005) Ten Years of Experience with PediatricNeuroendoscopic Third Ventriculostomy: Features and Perioperative Complications of 210 Cases. J NeurosurgAnesthesiol 17(1):33-7
  • 19 Schubert A, Deogaonkar A, Lotto M. Anesthesia for minimally invasive cranial and spinal surgery. J Neurosurg Anesthesiol 2006;18:47-56.
  • 20 Oertel J, Linsler S, Emmerich C, Keiner D, Gaab M, Schroeder H, et al. Results of combined intraventricular neuroendoscopic procedures in 130 cases with special focus on fornix contusions. World Neurosurg 2017;108:817-25.
  • 21 Martínez-Moreno M, Widhalm G, Mert A, Kiesel B, Bukaty A, Furtner J, et al. A novel protocol of continuous navigation guidance for endoscopic third ventriculostomy.Neurosurgery 2014;10:514-24.
  • 22 Raslau FD, Augustinack JC, Klein AP, Ulmer JL, Mathews VP, Mark LP. Memory part 3: The role of the fornix and clinical cases. AJNR Am J Neuroradiol 2015;36:1604-8.
  • 23 Bouras T, Sgouros S. Complications of endoscopic third ventriculostomy: A systematic review. In: Aygok G, Rekate H, editors. Hydrocephalus. Acta Neurochirurgica Supplementum. Vol. 113. Vienna: Springer; 2012.
  • 24 Oertel JM, Mondorf Y, Schroeder HW, Gaab MR. Endoscopic diagnosis and treatment of far distal obstructive hydrocephalus. Acta Neurochir (Wien) 2010;152:229-40.
  • 25 Ozgural O, Gokmen K, Giuseppe C, Umit E, Ihsan D, Eyyub SM, et al. Marking basilar artery using neuronavigation during endoscopic third ventriculostomy: A clinical study. Turk Neurosurg 2020;30:23-9.
  • 26 Broggi G, Dones I, Ferroli P, Franzini A, Servello D, Duca S. Image guided neuroendoscopy for third ventriculostomy. Acta Neurochir 2000;142:893-9.