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Giuseppe Cinalli - One of the best experts on this subject based on the ideXlab platform.
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long term results of endoscopic Third Ventriculostomy an outcome analysis
Journal of Neurosurgery, 2015Co-Authors: Sonja Vulcu, Giuseppe Cinalli, Leonie Eickele, Wolfgang Wagner, Joachim OertelAbstract:OBJECT Endoscopic Third Ventriculostomy (ETV) is the procedure of choice in the treatment of obstructive hydrocephalus. The excellent clinical and radiological success rates are well known. Nevertheless, very few papers have addressed the very long term outcomes of the procedure in very large series. The authors present a large case series of 113 patients who underwent 126 ETVs, and they highlight the initial postoperative outcome after 3 months and long-term follow-up with an average of 7 years. METHODS All patients who underwent ETV at the Department of Neurosurgery, Mainz University Hospital, between 1993 and 1999 were evaluated. Obstructive hydrocephalus was the causative pathology in all cases. RESULTS The initial clinical success rate was 82% and decreased slightly to 78% during long-term follow-up. Long-term success was analyzed using Kaplan-Meier curves. Overall, ETV failed in 31 patients. These patients underwent a second ETV or shunt treatment. A positive impact on long-term success was seen for...
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Endoscopic Third Ventriculostomy for idiopathic aqueductal stenosis.
World Neurosurgery, 2013Co-Authors: Pietro Spennato, Giuseppe Cinalli, Sanna Tazi, Olivier Bekaert, Philippe DecqAbstract:Background Idiopathic aqueductal stenosis is a cause of noncommunicating hydrocephalus, which actual treatment with endoscopic Third Ventriculostomy (ETV) could assess without any interference with the etiology. The results of ETV in this indication therefore could be interpreted as the result of the surgical procedure alone, without any additional factors related to the etiology of the cerebrospinal fluid pathway obstruction, such as hemorrhage, infection, brain malformations, or brain tumors or cysts. Methods After a brief description of pathogenesis of hydrocephalus in aqueductal stenosis, the authors review the literature for studies on ETV, extrapolating patients with idiopathic aqueductal stenosis in infancy, childhood, and adulthood. Differences in outcome between patients treated with ETV and patients treated with ventriculoperitoneal shunt (VPS) are also reviewed. Results The overall success rates of ETV range between 23% to 94%, with a mean of 68%; when only patients affected by obstructive triventricular hydrocephalus secondary to aqueductal stenosis are considered, the success rate is actually quite homogeneous and stable, being above 60% at any age, even if a trend in lower success rate in very young infants (younger than 6 months of age) is noticeable. The few reports on intellectual outcome failed to demonstrate differences between ETV and VPS. Conclusions Several issues, such as the cause of failures in well-selected patients, long-term outcome in infants treated with ETV, effects of persistent ventriculomegaly on neuropsychological developmental, remain unanswered. Larger and more detailed studies are needed.
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intracranial pressure monitoring and lumbar puncture after endoscopic Third Ventriculostomy in children
Neurosurgery, 2006Co-Authors: Giuseppe Cinalli, Pietro Spennato, Michel Zerah, Claudio Ruggiero, Ferdinando Aliberti, Emilio Cianciulli, Vincenzo Trischitta, Giuseppe MaggiAbstract:OBJECTIVE: The aim of this study is to analyze changes in intracranial pressure (ICP) after endoscopic Third Ventriculostomy (ETV) performed in children affected by non-communicating hydrocephalus. METHODS: ICP was continuously recorded for an average of 7 days in 64 children who underwent 68 ETVs for obstructive triventricular hydrocephalus of various etiology. In the first group (44 children), ETV was performed as the primary treatment; in the second group (20 children), the patients presented with shunt malfunction and underwent ETV and shunt removal. Three of the patients in the second group were reoperated for obstruction of the stoma: two were reoperated once and one was reoperated twice. RESULTS: ICP changes after ETV were not homogeneous and varied according to etiology: the highest values were observed in patients affected by posterior fossa tumors and the lowest values were seen in patients operated on during shunt malfunction and who had their shunt removed. After 31 procedures (45.6%), ICP remained normal (<20 mmHg) for the entire duration of the monitoring. After 37 procedures (54.5%), ICP was persistently high on Day 1 (mean, 29.7) and decreased very slowly in the subsequent days, remaining high for 2-9 days (mean, 4.5). After 20 of the 37 procedures with high postoperative ICP, patients presented symptoms of intracranial hypertension that resolved, in most of the cases, with one or two lumbar punctures. Lumbar puncture was noted to be effective in bringing about fast normalization of the ICP and resolution of the symptoms. In 13 patients (19.1%), ETV failed and a ventriculoperitoneal shunt was implanted. After four procedures, the stoma obstructed and the patients were treated, reopening the stoma. Postoperative ICP was not statistically significant higher in the patients in whom ETV failed. CONCLUSION: The high ICP observed in a group of patients in the early postoperative days is probably related to the slow permeation of the subarachnoid spaces by the cerebrospinal fluid flowing out of the Third Ventriculostomy. Management of intracranial hypertension after ETV remains a matter of controversy. The role of the lumbar puncture in the faster normalization of the ICP is examined in this article. By increasing the compliance and the buffering capacities of the spinal subarachnoid spaces, it probably decreases the cerebrospinal fluid outflow resistance from the ventricular system, facilitating the decrease of the ventricular volume and allowing faster permeation of the intracranial subarachnoid spaces. High postoperative ICP can account for persistent symptoms of intracranial hypertension and ventricular dilatation on computed tomographic scans after Third Ventriculostomy. A cycle of one to three lumbar punctures should always be performed in patients who remain symptomatic and who show increasing ventricular dilatation after ETV, before ETV is assumed to have failed and an extracranial cerebrospinal fluid shunt is implanted.
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endoscopic Third Ventriculostomy in the treatment of hydrocephalus in posterior fossa tumors in children
Childs Nervous System, 2004Co-Authors: Claudio Ruggiero, Giuseppe Cinalli, Pietro Spennato, Ferdinando Aliberti, Emilio Cianciulli, Vincenzo Trischitta, Giuseppe MaggiAbstract:Object The purpose of the present study is to assess the effectiveness of endoscopic Third Ventriculostomy (ETV) in children with hydrocephalus related to posterior fossa tumors.
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endoscopic Third Ventriculostomy in the treatment of hydrocephalus in posterior fossa tumors in children
Childs Nervous System, 2004Co-Authors: Claudio Ruggiero, Giuseppe Cinalli, Pietro Spennato, Ferdinando Aliberti, Emilio Cianciulli, Vincenzo Trischitta, Giuseppe MaggiAbstract:The purpose of the present study is to assess the effectiveness of endoscopic Third Ventriculostomy (ETV) in children with hydrocephalus related to posterior fossa tumors. Between September 1999 and December 2002, 63 children with posterior fossa tumors were treated at Santobono Hospital in Naples, Italy. Twenty-six patients had severe hydrocephalus. In order to relieve intracranial hypertension before tumor removal, 20 were treated with ETV, and 6 with ventriculo-peritoneal (VP) shunts. Twenty patients with mild hydrocephalus were treated with diuretics, corticosteroid agents, and early posterior fossa surgery, and 17 patients who did not have hydrocephalus were treated by elective posterior fossa surgery. Another 4 ETV were performed in the management of postoperative hydrocephalus. Preoperative ETV procedures were technically successful. One was complicated by intraventricular bleeding. The successful 19 preoperative ETV resolved intracranial hypertension before posterior fossa surgery in all cases. Three of these 19 patients developed postoperative hydrocephalus and were treated by VP shunt insertion after posterior fossa surgery. Out of the 4 ETV performed after posterior fossa surgery, only 2 were successful, both when the shunt malfunctioned. Endoscopic Third Ventriculostomy should be considered as an alternative procedure to ventriculo-peritoneal shunting and external ventricular draining for the emergency control of severe hydrocephalus caused by posterior fossa tumors, since it can quickly eliminate symptoms, and hence, can delay surgery scheduling if required. Even though ETV does not prevent postoperative hydrocephalus in all cases, it does protect against acute postoperative hydrocephalus due to cerebellar swelling. In addition, it eliminates the risks of cerebrospinal fluid (CSF) infection related to external drainage and minimizes the risk of overdrainage because it provides more physiological CSF drainage than the other procedures. Since postoperative hydrocephalus is very often physically obstructive, ETV should always be considered a possible treatment procedure.
Abhaya V Kulkarni - One of the best experts on this subject based on the ideXlab platform.
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the quality of youtube videos on endoscopic Third Ventriculostomy and endoscopic Third Ventriculostomy with choroid plexus cauterization procedures available to families of patients with pediatric hydrocephalus
Journal of Neurosurgery, 2020Co-Authors: Nicholas Sader, Abhaya V Kulkarni, Matthew E Eagles, Salim Ahmed, Jenna E Koschnitzky, Jay RivacambrinAbstract:OBJECTIVE YouTube has become an important information source for pediatric neurosurgical patients and their families. The goal of this study was to determine whether the informative quality of videos of endoscopic Third Ventriculostomy (ETV) and endoscopic Third Ventriculostomy with choroid plexus cauterization (ETV + CPC) is associated with metrics of popularity. METHODS This cross-sectional study used comprehensive search terms to identify videos pertaining to ETV and ETV + CPC presented on the first 3 pages of search results on YouTube. Two pediatric neurosurgeons, 1 neurosurgery resident, and 2 patient families independently reviewed the selected videos. Videos were assessed for overall informational quality by using a validated 5-point Global Quality Score (GQS) and compared to online metrics of popularity and engagement such as views, likes, likes/views ratio, comments/views ratio, and likes/dislikes ratio. Weighted kappa scores were used to measure agreement between video reviewers. RESULTS A total of 58 videos (47 on ETV, 7 on ETV + CPC, 4 on both) of 120 videos assessed met the inclusion criteria. Video styles included "technical" (62%), "lecture" (24%), "patient testimonial" (4%), and "other" (10%). In terms of GQS, substantial agreement was seen between surgeons (kappa 0.67 [95% CI 0.55, 0.80]) and excellent agreement was found between each surgeon and the neurosurgical resident (0.77 [95% CI 0.66, 0.88] and 0.89 [95% CI 0.82, 0.97]). Only fair to moderate agreement was seen between professionals and patient families, with weighted kappa scores ranging from 0.07 to 0.56. Academic lectures were more likely to be rated good or excellent (64% vs 0%, p < 0.001) versus surgical procedure and testimonial video types. There were significant associations between a better GQS and more likes (p = 0.01), views (p = 0.02), and the likes/dislikes ratio (p = 0.016). The likes/views ratio (p = 0.31) and comments/views ratio (p = 0.35) were not associated with GQS. The number of likes (p = 0.02), views (p = 0.03), and the likes/dislikes ratio (p = 0.015) were significantly associated with video style (highest for lecture-style videos). CONCLUSIONS Medical professionals tended to agree when assessing the overall quality of YouTube videos, but this agreement was not as strongly seen when compared to parental ratings. The online metrics of likes, views, and likes/dislikes ratio appear to predict quality. Neurosurgeons seeking to increase their online footprint via YouTube would be well advised to focus more on the academic lecture style because these were universally better rated.
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endoscopic Third Ventriculostomy with choroid plexus cauterization etv cpc versus csf shunting
2019Co-Authors: Abhaya V KulkarniAbstract:Choroid plexus removal and cautery was described a century ago, but went out of vogue due to its technical difficulty and associated morbidity. From the 1950s to 2000s, cerebrospinal fluid shunts and endoscopic Third Ventriculostomy (ETV) remained the mainstay of treatment for pediatric hydrocephalus, including infants. In the 2000s, Warf’s innovative development of the modern ETV with choroid plexus cauterization (CPC) technique and robust scientific study in the unique setting of the CURE Children’s Hospital of Uganda brought a renaissance of choroid plexus obliteration as a safe and effective treatment option. This chapter recounts the history of choroid plexus surgery, explains its biologic and pathophysiologic basis, describes the operative technique and outcome of ETV+CPC in the global setting, and compares it with other conventional treatments.
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international infant hydrocephalus study initial results of a prospective multicenter comparison of endoscopic Third Ventriculostomy etv and shunt for infant hydrocephalus
Childs Nervous System, 2016Co-Authors: Abhaya V Kulkarni, Spyros Sgouros, Shlomi Constantini, Iihs InvestigatorsAbstract:Introduction The IIHS is an international, prospective, multicenter study to compare endoscopic Third Ventriculostomy (ETV) and shunt in infants (<24 months old) with symptomatic triventricular hydrocephalus from aqueductal stensosis. Recruitment started in 2004, and here, we present the first results of IIHS.
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evaluating the children s hospital of alabama endoscopic Third Ventriculostomy experience using the endoscopic Third Ventriculostomy success score an external validation study
Journal of Neurosurgery, 2011Co-Authors: Robert P Naftel, Abhaya V Kulkarni, Gavin T Reed, John C WellonsAbstract:Object Endoscopic Third Ventriculostomy (ETV) success is dependent on patient characteristics including age, origin of hydrocephalus, and history of shunt therapy. Using these factors, an Endoscopic Third Ventriculostomy Success Score (ETVSS) model was constructed to predict success of therapy. This study reports a single-institution experience with ETV and explores the ETVSS model validity. Methods A retrospective chart review identified 151 consecutive patients who underwent ETV at a pediatric hospital between August 1995 and December 2009. Of these 151, 136 patients had at least 6 months of clinical follow-up. Data concerning patient characteristics, operative characteristics, radiological findings, complications, and success of ETV were collected. The actual success rates were compared with those predicted by the ETVSS model. Results The actual success rate of ETV at 6 months was 68.4% (93 of 136 patients), which compared well to the predicted ETVSS of 76.5% ± 12.5% (± SD). The C-statistic was 0.74 (9...
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endoscopic Third Ventriculostomy in the treatment of childhood hydrocephalus in uganda report of a scoring system that predicts success
Journal of Neurosurgery, 2010Co-Authors: Benjamin C Warf, John Mugamba, Abhaya V KulkarniAbstract:Object In Uganda, childhood hydrocephalus is common and difficult to treat. In some children, endoscopic Third Ventriculostomy (ETV) can be successful and avoid dependence on a shunt. This can be especially beneficial in Uganda, because of the high risk of infection and long-term failure associated with shunting. Therefore, the authors developed and validated a model to predict the chances of ETV success, taking into account the unique characteristics of a large sub-Saharan African population. Methods All children presenting with hydrocephalus at CURE Children's Hospital of Uganda (CCHU) between 2001 and 2007 were offered ETV as first-line treatment and were prospectively followed up. A multivariable logistic regression model was built using ETV success at 6 months as the outcome. The model was derived on 70% of the sample (training set) and validated on the remaining 30% (validation set). Results Endoscopic Third Ventriculostomy was attempted in 1406 patients. Of these, 427 were lost to follow-up prior t...
Christian Sainterose - One of the best experts on this subject based on the ideXlab platform.
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management of hydrocephalus in pediatric patients with posterior fossa tumors the role of endoscopic Third Ventriculostomy
Journal of Neurosurgery, 2001Co-Authors: Christian Sainterose, Giuseppe Cinalli, Michel Zerah, Paul Chumas, Franck E Roux, William Maixner, Maheir Mansour, Alexandre Carpentier, Marie Bourgeois, Alain PierrekahnAbstract:Object. The authors undertook a study to evaluate the effectiveness of endoscopic Third Ventriculostomy in the management of hydrocephalus before and after surgical intervention for posterior fossa tumors in children. Methods. Between October 1, 1993, and December 31, 1997, a total of 206 consecutive children with posterior fossa tumors underwent surgery at Hopital Necker—Enfants Malades in Paris. Excluded were 10 patients in whom shunts had been placed at the referring hospital. The medical records and neuroimaging studies of the remaining 196 patients were reviewed and categorized into three groups: Group A, 67 patients with hydrocephalus present on admission in whom endoscopic Third Ventriculostomy was performed prior to tumor removal; Group B, 82 patients with hydrocephalus who did not undergo preliminary Third Ventriculostomy but instead received conventional treatment; and Group C, 47 patients in whom no ventricular dilation was present on admission. There were no significant differences between pat...
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failure of Third Ventriculostomy in the treatment of aqueductal stenosis in children
Neurosurgical Focus, 1999Co-Authors: Giuseppe Cinalli, Michel Zerah, Christian Sainterose, Paul Chumas, Francis Brunelle, G Lot, Alain Pierrekahn, Dominique RenierAbstract:Object. The goal of this study was to analyze the types of failure and long-term efficacy of Third Ventriculostomy in children. Methods. The authors retrospectively analyzed clinical data obtained in 213 children affected by obstructive triventricular hydrocephalus who were treated by Third Ventriculostomy between 1973 and 1997. There were 120 boys and 93 girls. The causes of the hydrocephalus included: aqueductal stenosis in 126 cases; toxoplasmosis in 23 cases, pineal, mesencephalic, or tectal tumor in 42 cases; and other causes in 22 cases. In 94 cases, the procedure was performed using ventriculographic guidance (Group I) and in 119 cases by using endoscopic guidance (Group II). In 19 cases (12 in Group I and seven in Group II) failure was related to the surgical technique. Three deaths related to the technique were observed in Group I. For the remaining patients, Kaplan-Meier survival analysis showed a functioning Third Ventriculostomy rate of 72% at 6 years with a mean follow-up period of 45.5 months (range 4 days-17 years). No significant differences were found during long-term follow up between the two groups. In Group I, a significantly higher failure rate was seen in children younger than 6 months of age, but this difference was not observed in Group II. Thirty-eight patients required reoperation (21 in Group I and 17 in Group II) because of persistent or recurrent intracranial hypertension. In 29 patients shunt placement was necessary. In nine patients in whom there was radiologically confirmed obstruction of the stoma, the Third Ventriculostomy was repeated; this was successful in seven cases. Cine phase-contrast (PC) magnetic resonance (MR) imaging studies were performed in 15 patients in Group I at least 10 years after they had undergone Third Ventriculostomy (range 10-17 years, median 14.3 years); this confirmed long-term patency of the stoma in all cases. Conclusions. Third Ventriculostomy effectively controls obstructive triventricular hydrocephalus in more than 70% of children and should be preferred to placement of extracranial cerebrospinal shunts in this group of patients. When performed using ventriculographic guidance, the technique has a higher mortality rate and a higher failure rate in children younger than 6 months of age and is, therefore, no longer preferred. When Third Ventriculostomy is performed using endoscopic guidance, the same long-term results are achieved in children younger than 6 months of age as in older children and, thus, patient age should no longer be considered as a contraindication to using the technique. Delayed failures are usually secondary to obstruction of the stoma and often can be managed by repeating the procedure. Midline sagittal T2-weighted MR imaging sequences combined with cine PC MR imaging flow measurements provide a reliable tool for diagnosis of aqueductal stenosis and for ascertaining the patency of the stoma during follow-up evaluation.
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failure of Third Ventriculostomy in the treatment of aqueductal stenosis in children
Journal of Neurosurgery, 1999Co-Authors: Giuseppe Cinalli, Michel Zerah, Christian Sainterose, Paul Chumas, Francis Brunelle, G Lot, Alain Pierrekahn, Dominique RenierAbstract:Object. The goal of this study was to analyze the types of failure and long-term efficacy of Third Ventriculostomy in children. Methods. The authors retrospectively analyzed clinical data obtained in 213 children affected by obstructive triventricular hydrocephalus who were treated by Third Ventriculostomy between 1973 and 1997. There were 120 boys and 93 girls. The causes of the hydrocephalus included: aqueductal stenosis in 126 cases; toxoplasmosis in 23 cases, pineal, mesencephalic, or tectal tumor in 42 cases; and other causes in 22 cases. In 94 cases, the procedure was performed using ventriculographic guidance (Group I) and in 119 cases by using endoscopic guidance (Group II). In 19 cases (12 in Group I and seven in Group II) failure was related to the surgical technique. Three deaths related to the technique were observed in Group I. For the remaining patients, Kaplan—Meier survival analysis showed a functioning Third Ventriculostomy rate of 72% at 6 years with a mean follow-up period of 45.5 month...
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the role of endoscopic Third Ventriculostomy in the management of shunt malfunction
Neurosurgery, 1998Co-Authors: Giuseppe Cinalli, Conor Mallucci, Cristian Salazar, Jose Zanoni Yada, Michel Zerah, Christian SainteroseAbstract:Objective To evaluate the effectiveness of Third Ventriculostomy as an alternative to shunt revision in the management of shunt malfunction and infection in obstructive hydrocephalus. Methods All of the clinical notes of 30 patients treated with Third Ventriculostomy for malfunctioning or infected shunts between January 1, 1974, and December 31, 1996, were retrospectively reviewed. Third Ventriculostomy was performed under fluoroscopic control in the first seven patients and endoscopically in the remainder. A successful outcome was achieved if further shunt revision surgery was avoided. The median follow-up duration was 8.7 years Results Twenty-three patients (76.7%) experienced successful outcomes, resulting in shunt independence. Of the seven failures, three were technical failures at the time of surgery and the remaining four were manifest within a median of 10 days, resulting in shunt revision. There have been no delayed failures. Conclusion Third Ventriculostomy is a valuable alternative to shunt revision in patients affected by obstructive hydrocephalus presenting with shunt malfunction or infection. It should be considered in all suitable cases as the first-line treatment for obstructive hydrocephalus of all causes. Because all failures were manifest within a short time, it is likely that these successes will be durable.
Michel Zerah - One of the best experts on this subject based on the ideXlab platform.
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intracranial pressure monitoring and lumbar puncture after endoscopic Third Ventriculostomy in children
Neurosurgery, 2006Co-Authors: Giuseppe Cinalli, Pietro Spennato, Michel Zerah, Claudio Ruggiero, Ferdinando Aliberti, Emilio Cianciulli, Vincenzo Trischitta, Giuseppe MaggiAbstract:OBJECTIVE: The aim of this study is to analyze changes in intracranial pressure (ICP) after endoscopic Third Ventriculostomy (ETV) performed in children affected by non-communicating hydrocephalus. METHODS: ICP was continuously recorded for an average of 7 days in 64 children who underwent 68 ETVs for obstructive triventricular hydrocephalus of various etiology. In the first group (44 children), ETV was performed as the primary treatment; in the second group (20 children), the patients presented with shunt malfunction and underwent ETV and shunt removal. Three of the patients in the second group were reoperated for obstruction of the stoma: two were reoperated once and one was reoperated twice. RESULTS: ICP changes after ETV were not homogeneous and varied according to etiology: the highest values were observed in patients affected by posterior fossa tumors and the lowest values were seen in patients operated on during shunt malfunction and who had their shunt removed. After 31 procedures (45.6%), ICP remained normal (<20 mmHg) for the entire duration of the monitoring. After 37 procedures (54.5%), ICP was persistently high on Day 1 (mean, 29.7) and decreased very slowly in the subsequent days, remaining high for 2-9 days (mean, 4.5). After 20 of the 37 procedures with high postoperative ICP, patients presented symptoms of intracranial hypertension that resolved, in most of the cases, with one or two lumbar punctures. Lumbar puncture was noted to be effective in bringing about fast normalization of the ICP and resolution of the symptoms. In 13 patients (19.1%), ETV failed and a ventriculoperitoneal shunt was implanted. After four procedures, the stoma obstructed and the patients were treated, reopening the stoma. Postoperative ICP was not statistically significant higher in the patients in whom ETV failed. CONCLUSION: The high ICP observed in a group of patients in the early postoperative days is probably related to the slow permeation of the subarachnoid spaces by the cerebrospinal fluid flowing out of the Third Ventriculostomy. Management of intracranial hypertension after ETV remains a matter of controversy. The role of the lumbar puncture in the faster normalization of the ICP is examined in this article. By increasing the compliance and the buffering capacities of the spinal subarachnoid spaces, it probably decreases the cerebrospinal fluid outflow resistance from the ventricular system, facilitating the decrease of the ventricular volume and allowing faster permeation of the intracranial subarachnoid spaces. High postoperative ICP can account for persistent symptoms of intracranial hypertension and ventricular dilatation on computed tomographic scans after Third Ventriculostomy. A cycle of one to three lumbar punctures should always be performed in patients who remain symptomatic and who show increasing ventricular dilatation after ETV, before ETV is assumed to have failed and an extracranial cerebrospinal fluid shunt is implanted.
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management of hydrocephalus in pediatric patients with posterior fossa tumors the role of endoscopic Third Ventriculostomy
Journal of Neurosurgery, 2001Co-Authors: Christian Sainterose, Giuseppe Cinalli, Michel Zerah, Paul Chumas, Franck E Roux, William Maixner, Maheir Mansour, Alexandre Carpentier, Marie Bourgeois, Alain PierrekahnAbstract:Object. The authors undertook a study to evaluate the effectiveness of endoscopic Third Ventriculostomy in the management of hydrocephalus before and after surgical intervention for posterior fossa tumors in children. Methods. Between October 1, 1993, and December 31, 1997, a total of 206 consecutive children with posterior fossa tumors underwent surgery at Hopital Necker—Enfants Malades in Paris. Excluded were 10 patients in whom shunts had been placed at the referring hospital. The medical records and neuroimaging studies of the remaining 196 patients were reviewed and categorized into three groups: Group A, 67 patients with hydrocephalus present on admission in whom endoscopic Third Ventriculostomy was performed prior to tumor removal; Group B, 82 patients with hydrocephalus who did not undergo preliminary Third Ventriculostomy but instead received conventional treatment; and Group C, 47 patients in whom no ventricular dilation was present on admission. There were no significant differences between pat...
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failure of Third Ventriculostomy in the treatment of aqueductal stenosis in children
Neurosurgical Focus, 1999Co-Authors: Giuseppe Cinalli, Michel Zerah, Christian Sainterose, Paul Chumas, Francis Brunelle, G Lot, Alain Pierrekahn, Dominique RenierAbstract:Object. The goal of this study was to analyze the types of failure and long-term efficacy of Third Ventriculostomy in children. Methods. The authors retrospectively analyzed clinical data obtained in 213 children affected by obstructive triventricular hydrocephalus who were treated by Third Ventriculostomy between 1973 and 1997. There were 120 boys and 93 girls. The causes of the hydrocephalus included: aqueductal stenosis in 126 cases; toxoplasmosis in 23 cases, pineal, mesencephalic, or tectal tumor in 42 cases; and other causes in 22 cases. In 94 cases, the procedure was performed using ventriculographic guidance (Group I) and in 119 cases by using endoscopic guidance (Group II). In 19 cases (12 in Group I and seven in Group II) failure was related to the surgical technique. Three deaths related to the technique were observed in Group I. For the remaining patients, Kaplan-Meier survival analysis showed a functioning Third Ventriculostomy rate of 72% at 6 years with a mean follow-up period of 45.5 months (range 4 days-17 years). No significant differences were found during long-term follow up between the two groups. In Group I, a significantly higher failure rate was seen in children younger than 6 months of age, but this difference was not observed in Group II. Thirty-eight patients required reoperation (21 in Group I and 17 in Group II) because of persistent or recurrent intracranial hypertension. In 29 patients shunt placement was necessary. In nine patients in whom there was radiologically confirmed obstruction of the stoma, the Third Ventriculostomy was repeated; this was successful in seven cases. Cine phase-contrast (PC) magnetic resonance (MR) imaging studies were performed in 15 patients in Group I at least 10 years after they had undergone Third Ventriculostomy (range 10-17 years, median 14.3 years); this confirmed long-term patency of the stoma in all cases. Conclusions. Third Ventriculostomy effectively controls obstructive triventricular hydrocephalus in more than 70% of children and should be preferred to placement of extracranial cerebrospinal shunts in this group of patients. When performed using ventriculographic guidance, the technique has a higher mortality rate and a higher failure rate in children younger than 6 months of age and is, therefore, no longer preferred. When Third Ventriculostomy is performed using endoscopic guidance, the same long-term results are achieved in children younger than 6 months of age as in older children and, thus, patient age should no longer be considered as a contraindication to using the technique. Delayed failures are usually secondary to obstruction of the stoma and often can be managed by repeating the procedure. Midline sagittal T2-weighted MR imaging sequences combined with cine PC MR imaging flow measurements provide a reliable tool for diagnosis of aqueductal stenosis and for ascertaining the patency of the stoma during follow-up evaluation.
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failure of Third Ventriculostomy in the treatment of aqueductal stenosis in children
Journal of Neurosurgery, 1999Co-Authors: Giuseppe Cinalli, Michel Zerah, Christian Sainterose, Paul Chumas, Francis Brunelle, G Lot, Alain Pierrekahn, Dominique RenierAbstract:Object. The goal of this study was to analyze the types of failure and long-term efficacy of Third Ventriculostomy in children. Methods. The authors retrospectively analyzed clinical data obtained in 213 children affected by obstructive triventricular hydrocephalus who were treated by Third Ventriculostomy between 1973 and 1997. There were 120 boys and 93 girls. The causes of the hydrocephalus included: aqueductal stenosis in 126 cases; toxoplasmosis in 23 cases, pineal, mesencephalic, or tectal tumor in 42 cases; and other causes in 22 cases. In 94 cases, the procedure was performed using ventriculographic guidance (Group I) and in 119 cases by using endoscopic guidance (Group II). In 19 cases (12 in Group I and seven in Group II) failure was related to the surgical technique. Three deaths related to the technique were observed in Group I. For the remaining patients, Kaplan—Meier survival analysis showed a functioning Third Ventriculostomy rate of 72% at 6 years with a mean follow-up period of 45.5 month...
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the role of endoscopic Third Ventriculostomy in the management of shunt malfunction
Neurosurgery, 1998Co-Authors: Giuseppe Cinalli, Conor Mallucci, Cristian Salazar, Jose Zanoni Yada, Michel Zerah, Christian SainteroseAbstract:Objective To evaluate the effectiveness of Third Ventriculostomy as an alternative to shunt revision in the management of shunt malfunction and infection in obstructive hydrocephalus. Methods All of the clinical notes of 30 patients treated with Third Ventriculostomy for malfunctioning or infected shunts between January 1, 1974, and December 31, 1996, were retrospectively reviewed. Third Ventriculostomy was performed under fluoroscopic control in the first seven patients and endoscopically in the remainder. A successful outcome was achieved if further shunt revision surgery was avoided. The median follow-up duration was 8.7 years Results Twenty-three patients (76.7%) experienced successful outcomes, resulting in shunt independence. Of the seven failures, three were technical failures at the time of surgery and the remaining four were manifest within a median of 10 days, resulting in shunt revision. There have been no delayed failures. Conclusion Third Ventriculostomy is a valuable alternative to shunt revision in patients affected by obstructive hydrocephalus presenting with shunt malfunction or infection. It should be considered in all suitable cases as the first-line treatment for obstructive hydrocephalus of all causes. Because all failures were manifest within a short time, it is likely that these successes will be durable.
Alain Pierrekahn - One of the best experts on this subject based on the ideXlab platform.
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management of hydrocephalus in pediatric patients with posterior fossa tumors the role of endoscopic Third Ventriculostomy
Journal of Neurosurgery, 2001Co-Authors: Christian Sainterose, Giuseppe Cinalli, Michel Zerah, Paul Chumas, Franck E Roux, William Maixner, Maheir Mansour, Alexandre Carpentier, Marie Bourgeois, Alain PierrekahnAbstract:Object. The authors undertook a study to evaluate the effectiveness of endoscopic Third Ventriculostomy in the management of hydrocephalus before and after surgical intervention for posterior fossa tumors in children. Methods. Between October 1, 1993, and December 31, 1997, a total of 206 consecutive children with posterior fossa tumors underwent surgery at Hopital Necker—Enfants Malades in Paris. Excluded were 10 patients in whom shunts had been placed at the referring hospital. The medical records and neuroimaging studies of the remaining 196 patients were reviewed and categorized into three groups: Group A, 67 patients with hydrocephalus present on admission in whom endoscopic Third Ventriculostomy was performed prior to tumor removal; Group B, 82 patients with hydrocephalus who did not undergo preliminary Third Ventriculostomy but instead received conventional treatment; and Group C, 47 patients in whom no ventricular dilation was present on admission. There were no significant differences between pat...
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failure of Third Ventriculostomy in the treatment of aqueductal stenosis in children
Neurosurgical Focus, 1999Co-Authors: Giuseppe Cinalli, Michel Zerah, Christian Sainterose, Paul Chumas, Francis Brunelle, G Lot, Alain Pierrekahn, Dominique RenierAbstract:Object. The goal of this study was to analyze the types of failure and long-term efficacy of Third Ventriculostomy in children. Methods. The authors retrospectively analyzed clinical data obtained in 213 children affected by obstructive triventricular hydrocephalus who were treated by Third Ventriculostomy between 1973 and 1997. There were 120 boys and 93 girls. The causes of the hydrocephalus included: aqueductal stenosis in 126 cases; toxoplasmosis in 23 cases, pineal, mesencephalic, or tectal tumor in 42 cases; and other causes in 22 cases. In 94 cases, the procedure was performed using ventriculographic guidance (Group I) and in 119 cases by using endoscopic guidance (Group II). In 19 cases (12 in Group I and seven in Group II) failure was related to the surgical technique. Three deaths related to the technique were observed in Group I. For the remaining patients, Kaplan-Meier survival analysis showed a functioning Third Ventriculostomy rate of 72% at 6 years with a mean follow-up period of 45.5 months (range 4 days-17 years). No significant differences were found during long-term follow up between the two groups. In Group I, a significantly higher failure rate was seen in children younger than 6 months of age, but this difference was not observed in Group II. Thirty-eight patients required reoperation (21 in Group I and 17 in Group II) because of persistent or recurrent intracranial hypertension. In 29 patients shunt placement was necessary. In nine patients in whom there was radiologically confirmed obstruction of the stoma, the Third Ventriculostomy was repeated; this was successful in seven cases. Cine phase-contrast (PC) magnetic resonance (MR) imaging studies were performed in 15 patients in Group I at least 10 years after they had undergone Third Ventriculostomy (range 10-17 years, median 14.3 years); this confirmed long-term patency of the stoma in all cases. Conclusions. Third Ventriculostomy effectively controls obstructive triventricular hydrocephalus in more than 70% of children and should be preferred to placement of extracranial cerebrospinal shunts in this group of patients. When performed using ventriculographic guidance, the technique has a higher mortality rate and a higher failure rate in children younger than 6 months of age and is, therefore, no longer preferred. When Third Ventriculostomy is performed using endoscopic guidance, the same long-term results are achieved in children younger than 6 months of age as in older children and, thus, patient age should no longer be considered as a contraindication to using the technique. Delayed failures are usually secondary to obstruction of the stoma and often can be managed by repeating the procedure. Midline sagittal T2-weighted MR imaging sequences combined with cine PC MR imaging flow measurements provide a reliable tool for diagnosis of aqueductal stenosis and for ascertaining the patency of the stoma during follow-up evaluation.
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failure of Third Ventriculostomy in the treatment of aqueductal stenosis in children
Journal of Neurosurgery, 1999Co-Authors: Giuseppe Cinalli, Michel Zerah, Christian Sainterose, Paul Chumas, Francis Brunelle, G Lot, Alain Pierrekahn, Dominique RenierAbstract:Object. The goal of this study was to analyze the types of failure and long-term efficacy of Third Ventriculostomy in children. Methods. The authors retrospectively analyzed clinical data obtained in 213 children affected by obstructive triventricular hydrocephalus who were treated by Third Ventriculostomy between 1973 and 1997. There were 120 boys and 93 girls. The causes of the hydrocephalus included: aqueductal stenosis in 126 cases; toxoplasmosis in 23 cases, pineal, mesencephalic, or tectal tumor in 42 cases; and other causes in 22 cases. In 94 cases, the procedure was performed using ventriculographic guidance (Group I) and in 119 cases by using endoscopic guidance (Group II). In 19 cases (12 in Group I and seven in Group II) failure was related to the surgical technique. Three deaths related to the technique were observed in Group I. For the remaining patients, Kaplan—Meier survival analysis showed a functioning Third Ventriculostomy rate of 72% at 6 years with a mean follow-up period of 45.5 month...