Clinical Features in Patients Requiring Reoperation after Failed Endoscopic Procedures for Hydrocephalus

The aim of this study was to clarify the clinical features of patients at risk of secondary obstruction following endoscopic fenestration. Clinical notes and endoscopic findings for 15 patients treated with endoscopic procedures were retrospectively reviewed. Endoscopic third ventriculostomy (ETV) was performed as initial treatment in 4 patients with non-communicating hydrocephalus, including a neonate with myelomeningocele, and as an alternative to shunt revision in 4 patients. Two patients with non-communicating hydrocephalus caused by tumor or arachnoid cyst were also managed with third ventriculostomy. Four patients with loculated hydrocephalus underwent endoscopic septostomy. A child with an isolated fourth ventricle was treated with endoscopic aqueductoplasty. Of the 15 patients undergoing endoscopic procedure, 4 required reoperation. Of the 10 patients treated with ETV, only the neonate with myelomeningocele required a ventriculoperitoneal shunt because of failure of the initial procedure. Of the 4 patients treated with endoscopic septostomy, 2 children with loculated hydrocephalus following intraventricular hemorrhage (IVH) underwent a second septostomy. In a patient with an isolated fourth ventricle following posthemorrhagic hydrocephalus, recurrence was noted 8 months after the initial procedure. He underwent a second procedure using a stent implanted into the aqueduct to maintain CSF circulation. Sufficient stomal size or implantation of a stent may be required in the under-2-year age group with hydrocephalus accompanied by IVH and associated with myelomeningocele, in whom the risk of secondary obstruction may be high.

Key words:

Aqueductoplasty - Endoscopy - Hydrocephalus - Septostomy - Third Ventriculostomy

References

• 1 Barlow P. Indication for endoscopic third ventriculostomy: a review of successful and failed cases.  Br J Neurosurg. 1997;  11 456
• 2 Buxton N, Macarthur D, Mallucci C, Punt J, Vloeberghs M. Neuroendoscopic third ventriculostomy in patients less than 1 year old.  Pediatr Neurosurg. 1998;  29 73-76
• 3 Cinalli G, Salazar C, Mallucci C, Yada J Z, Zerah M, Sainte-Rose C. The role of endoscopic third ventriculostomy in the management of shunt malfunction.  Neurosurgery. 1998;  43 1323-1329
• 4 Cinalli G, Sainte-Rose C, Chumas P, Zerah M, Brunelle F, Lot G, Pierre-Kahn A, Renier D. Failure of third ventriculostomy in the treatment of aqueductal stenoses in children.  J Neurosurg. 1999;  90 448-454
• 5 Cohen A R. Endoscopic ventricular surgery.  Pediatr Neurosurg. 1993;  19 127-134
• 6 Eller T W, Pasternak J F. Isolated ventricles following intraventricular hemorrhage.  J Neurosurg. 1985;  62 357-362
• 7 Hamada H, Hayashi N, Endo S, Kurimoto M, Hirashima Y, Takaku A. Endoscopic aqueductal plasty via the fourth ventricle through the cerebellar hemisphere under navigating system guidance.  Neuro Med Chir. 1999;  39 950-954
• 8 Hayashi N, Endo S, Tsukamoto E, Hohnoki S, Masuoka T, Takaku A. Endoscopic ventriculocystcisternostomy of a quadrigeminal arachnoid cyst. Case report.  J Neurosurg. 1999;  90 1125-1128
• 9 Heilman C, Cohen A R. Endoscopic ventricular fenestration using a “saline torch”.  J Neurosurg. 1991;  74 224-229
• 10 Hoffman H J, Harwood-Nash D, Gilday D L. Percutaneous third ventriculostomy in the management of noncommunicating hydrocephalus.  Neurosurgery. 1980;  7 313-321
• 11 Jaksche H, Loew F. Burr hole third ventriculo-cisternostomy.  Acta Neurochirurgica. 1986;  79 48-51
• 12 Jamjoom A B, Mohammed A A, Al-Boukai A, Jamjoom Z A, Rahman N, Jamjoom H T. Multiloculated hydrocephalus related to cerebrospinal fluid shunt infection.  Acta Neurochir. 1996;  138 714-719
• 13 Jones R FC, Stening W A, Brydon M. Endoscopic third ventriculostomy.  Neurosurgery. 1990;  26 86-91
• 14 Jones R FC, Kwok B CT, Stening W A, Vonau M. The current status of endoscopic third ventriculostomy in the management of non-communicating hydrocephalus.  Minim Invas Neurosurg. 1994;  37 28-36
• 15 Kehler U, Gliemroth J, Arnold H. Asymmetric hydrocephalus: safe endoscopic perforation of septum pellucidum. Technical note.  Minim Invas Neurosurg. 1997;  40 101-102
• 16 Kelly P J. Stereotactic third ventriculostomy in patients with nontumoral adlescent/adult onset aqueductal stenosis and symptomatic hydrocephalus.  J Neurosurg. 1991;  75 865-873
• 17 Kunz U, Goldmann A, Bader C, Waldbauer H, Oldenkott P. Endoscopic fenestration of the 3rd ventricular floor in a aqueductal stenosis.  Minim Invas Neurosurg. 1994;  37 42-47
• 18 Lewis A I, Keiper G L, Crone K R. Endoscopic treatment of loculated hydrocephalus.  J Neurosurg. 1995;  82 780-785
• 19 Matula C, Reinprecht A, Roessler K, Tschbitscer M, Koos W T. Endoscopic exploration of the IVth ventricle.  Minim Invas Neurosurg. 1996;  39 86-92
• 20 Nida T, Haines S J. Multiloculated hydrocephalus: craniotomy and fenestration of intraventricular septations.  J Neurosurg. 1993;  78 70-76
• 21 Oi S, Hidaka M, Honda Y, Togo K, Shinoda M, Shimoda M, Tsugane R, Sato O. Neuroendoscopic surgery for specific forms of hydrocephalus.  Child's Nerve Syst. 1999;  15 56-68
• 22 Oka K, Yamamoto M, Ikeda K, Tomonaga M. Flexible endoneurosurgical therapy for aqueductal stenosis.  Neurosurgery. 1993;  33 236-243
• 23 Teo C, Jones R. Management of hydrocephalus by endoscopic third ventriculostomy in patients with myelomeningocele.  Pediatr Neurosurg. 1996;  25 57-63
• 24 Umemura K, Hayashi N, Hamada H, Endo S, Takaku A. Endoscopic third ventriculostomy in a case of obstructive hydrocephalus with neurofibromatosis (NF-1).  Brain and Nerve (Japanese). 1998;  50 427-431
• 25 Varies J K. An endoscopic technique for third ventriculostomy.  Surg Neurol. 1978;  9 165-168
• 26 Yamamoto M, Oka K, Ikeda K, Tomonaga M. Percutaneous flexible neuroendoscopic ventriculostomy in patients with shunt malfunction as an alternative procedure to shunt revision.  Surg Neurol. 1994;  42 218-223

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