ENDOSCOPIC THIRD VENTRICULOSTOMY: OUTCOME ANALYSIS IN 170 PROCEDURES

Main Article Content

Khalid Khanzada
Zia Ur Rehman

Abstract

OBJECTIVE: To analyze the outcome of endoscopic third ventriculostomy (ETV) in the management of obstructive hydrocephalus (OHC).

METHODOLOGY: This observational study was conducted at department of neurosurgery, Lady Reading hospital, Peshawar Pakistan from January 2009 to June 2012. During the study period, 130 cases of OHC secondary to posterior fossa tumor undergoing ETV were selected for study through convenient sampling method. The exclusion criteria consisted of patient’s age <6 months, previous history of ETV, recurrent tumor, and Kornofsky score <60. Data was collected on a proforma and analyzed by SPSS-16. 

RESULTS: Out of 170 patients, 94 (55.3%) were males and 76 (44.7%) were females, ranging in age from 1-45 years. Ninety (52.9%) cases were <5 years of age and 45 cases (26.5%) were in the 6-10 year age group. ETV had successful outcome in 135 (79.4%) patients. Ventriculoperitoneal shunt   was required in 14 (8.24%) patients for inadequate ventriculostomy. Ventricular drainage device was inserted in 8 (4.7%) cases for hemorrhagic CSF. Complications were observed in 39 (22.9%) cases including inadequate ventriculostomy (8.24%), ventricular bleed (4.7%), CSF leak (2.4%), asymptomatic pneumocephlus (1.2%), seizures (1.2%) and meningitis (1.2%). Five patients (2.94%) died; 2 (1.2%) each due to reverse conning and ventricular bleed and one (0.6%) due to CSF leak with meningitis.

CONCLUSION: ETV has success rate of 79.4% in OHC with complication rate of 22.9% and mortality rate of 2.94%. Complications can be reduced by proper selection of patients, detailed plan and skilful performance of surgery in experienced hands and meticulous postoperative care. 

 

Article Details

How to Cite
Khanzada, K., and Z. Rehman. “ENDOSCOPIC THIRD VENTRICULOSTOMY: OUTCOME ANALYSIS IN 170 PROCEDURES”. KHYBER MEDICAL UNIVERSITY JOURNAL, Vol. 6, no. 1, Mar. 2014, pp. 25-30, https://www.kmuj.kmu.edu.pk/article/view/12389.
Section
Original Articles
Author Biography

Khalid Khanzada, PGMI LRH PESHAWAR

Assist prof Deptt of neurosurgery PGMI LRH PESHAWAR

References

1. Bognar L, Borgulya G, Benke P, Madarassy G: Analysis of CSF shunting procedure requirement in children with posterior fossa tumors. Childs Nerv Syst 2003, 19: 332-336
2. Dubey A, Sung WS, Shaya M, Patwardhan R, Willis B, Smith D, Nanda A. Complications of posterior cranial fossa surgery—an institutional experience of 500 patients. Surgical Neurology 2009;72:369–75
3. De-Bont JM, Packer RJ, Michiels EM, Den-Boer ML, Pieters R. Biological background of pediatric medulloblastoma and ependymoma: A review from a translational research perspective. Neuro Oncol 2008;10(6):1040–60.
4. Karajannis M, Allen JC, Newcomb EW. Treatment of Pediatric Brain Tumors. J Cell Physiol 2008;217(3):584–89.
5. Rieken S, Gaiser T, Mohr A, Welzel T, Witt O, Kulozik AE et al. Outcome and prognostic factors of desmoplastic medulloblastoma treated within a multidisciplinary treatment concept. BMC Cancer 2010;10:450.
6. Hafez RFA. Stereotaxic gamma knife surgery in treatment of critically located pilocytic astrocytoma: preliminary result. World Journal of Surgical Oncology 2007;5:39.
7. Hoff KV, Kieffer V, Habrand JL, Kalifa C, Dellatolas G, Grill J. Impairment of intellectual functions after surgery and posterior fossa irradiation in children with ependymoma is related to age and neurologic complications. BMC Cancer 2008;8:15.
8. Song DK, Lonser RR. Pathological satiety caused by brainstem hemangioblastoma. J Neurosurg Pediatr. 2008;2(6):397–401.
9. Hopf NJ, Grunert P, Fries G. Endoscopic third ventriculostomy: outcome analysis of 100 consecutive procedures. Neurosurg 1999, 44(4): 795-804; Discussion 804-806
10. Lee M, Wisoff JH, Abbott R: Management of hydrocephalus in children with medulloblastomas: prognostic factors for shunting. Pediatr Neurosurg 1994, 20(4): 240-247
11. Valenzuela S, Trellez A: Pediatric neuroendoscopy in Chile: Analysis of the first 100 cases. Childs Nerv Syst 1999, 15(9): 457-460
12. Cinalli G: Alternatives to shunting. Childs Nerv Syst 1999, 15: 718-731
13. Chumas P, Saint-Rose C, Cinalli Gl: III ventriculostomy in the management of posterior fossa tumors in children. Proceedings of the ISPN congress, Santiago, Chile, 26-29 September 1995. Childs Nerv Syst 1995, 11: 540
14. Sainte-Rose C, Cinalli G, Roux FE: Management of hydrocephalus in pediatric patients with posterior fossa tumors: the role of endoscopic third ventriculostomy. J Neurosurg 2001, 95(5): 791-797
15. Culley DJ, Berger MS, Shaw D, Geyer R: An analysis of factors determining the need for ventriculoperitoneal shunts after posterior fossa tumor surgery in children. Neurosurg 1994, 34(3): 402-7; Discussion 407-8
16. Brohi SR, Brohi AR, Sidiqui MA, Mughal SA, Saeed S. Outcome of endoscopic third ventriculostomy in hydrocephalus. J Surg Pak (Inter) 2010;15(1):25-8.
17. Haq MIU, Khan SA, Raja RA, Ahmed E. Efficacy of endoscopic third ventriculostomy in noncommunicating hydrocephalus. J Ayub Med Coll Abbottabad 2012;24(2):144-6.
18. Rehman ZU, Khanzada K, Husain R, Ali M, Ali M. Experience with endoscopic third ventriculostomy in the management of hydrocephalus secondary to posterior fossa tumor. J Postgrad Med Inst 2013;27(4):433-8.
19. Ali M, Usman M, Khan Z, Khan KM, Hussain R, Khanzada K. Endoscopic third ventriculostomy for obstructive hydrocephalus. J Coll Physicians Surg Pak 2013; 23 (5): 338-41.
20. Epstein F, Murali R: Pediatric posterior fossa tumors: hazards of the “preoperative” shunt. Neurosurg 1978, 3(3): 348-350
21. Fiorillo A, Maggi G, Martone Al: Shunt-related abdominal metastases in an infant with medulloblastoma: long-term remission by systemic chemotherapy and surgery. J Neurooncol 2001, 52(3): 273-6
22. Gruss P, Gaab M, Knobloch OE: Disorders of CSF circulation after interventions in the area of the posterior cranial fossa with prior shunt operation. Adv Neurosurg 1978, 5: 199-202
23. McLaurin RL: Disadvantages of the preoperative shunt in posterior fossa tumors. Clin Neurosurg 1983, 30: 286-292
24. Muszynski CA, Laurent JP, Cheek WR: Effects of ventricular drainage and dural closure on cerebrospinal fluid leaks after posterior fossa tumor surgery. Pediatr Neurosurg 1994, 21:227-231
25. Valenzuela S, Trellez A. Pediatric neuroendoscopy in Chile. Analysis of the first 100 cases. Childs Nerv Syst 1999; 15:457-460.
26. Papo I, Caruselli G, Luongo A: External ventricular drainage in the management of posterior fossa tumors in children and adolescents. Neurosurg 1982, 10(1): 13-15
27. Taylor WAS, Todd NV, Leighton SEJ: CSF drainage in patients with posterior fossa tumours. Acta Neurochir (Wien) 1992, 117: 1-6
28. Riva-Cambrin R, Detsky AS, Lamberti-Pasculli M, Sargent MA, Armstrong D, Moineddin R, et al.: Predicting postresection hydrocephalus in pediatric patients with posterior fossa tumors. J Neurosurg Pediatr 2009;3 (5):378-85.
29. Bouras T1, Sgouros S. Complications of endoscopic third ventriculostomy. J Neurosurg Pediatr 2011;7(6):643-9.
30. Schmid UD, Seiler RW: Management of obstructive hydrocephalus secondary to posterior fossa tumors by steroids and subcutaneous ventricular catheter reservoir. J Neurosurg 1986, 65(5): 649-653
31. Rappaport ZH, Shalit MN: Perioperative external ventricular drainage in obstructive hydrocephalus secondary to infratentorial brain tumours. Acta Neurochir (Wien) 1989, 96: 118-121
32. Shalit MN, Ben Ari Y, Eynan N: The management of obstructive hydrocephalus by the use of external continuous ventricular drainage. Acta Neurochir (Wien) 1979, 47: 161-172.