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Giuseppe Cinalli - One of the best experts on this subject based on the ideXlab platform.
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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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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.
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.
Michael R Gaab - One of the best experts on this subject based on the ideXlab platform.
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endoscopic transventricular third Ventriculostomy through the lamina terminalis
Journal of Neurosurgery, 2010Co-Authors: Joachim Oertel, Henry W S Schroeder, Sonja Vulcu, Moritz A Konerding, Wolfgang Wagner, Michael R GaabAbstract:Object Endoscopic third Ventriculostomy (ETV) has become a well-accepted option for obstructive hydrocephalus. However, standard Ventriculostomy at the floor of the third ventricle might not be feasible under certain conditions. Here, the authors report in detail on their initial experience with an alternative option of endoscopic Ventriculostomy through the lamina terminalis via a transventricular route. Methods Endoscopic third Ventriculostomy through the lamina terminalis from a transventricular transforaminal route was evaluated in 4 cadaveric human heads and in 4 clinical cases. Results In all 4 human cadavers, an opening of the lamina terminalis via a transventricular approach could be achieved without injury to either the optic chiasm or the anterior cerebral arteries. In the 4 clinical cases, an accurate and reliable Ventriculostomy was performed at the lamina terminalis. The bur hole was placed directly at the coronal suture 2 cm lateral from the midline. After identifying the optic chiasm and th...
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endoscopic diagnosis and treatment of far distal obstructive hydrocephalus
Acta Neurochirurgica, 2010Co-Authors: Joachim Oertel, Henry W S Schroeder, Yvonne Mondorf, Michael R GaabAbstract:Purpose Obstruction of the CSF circulation distal to the fourth ventricle is a rare cause of noncommunicating hydrocephalus. Endoscopic third Ventriculostomy (ETV) represents one of the treatment options, but reports of results are rare.
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fatal subarachnoid hemorrhage after endoscopic third Ventriculostomy case report
Neurosurgical Focus, 1999Co-Authors: Henry W S Schroeder, Rolf Warzok, Jamal A Assaf, Michael R GaabAbstract:In recent years, endoscopic third Ventriculostomy has become a well-established procedure for the treatment of various forms of noncommunicating hydrocephalus. Endoscopic third Ventriculostomy is considered to be an easy and safe procedure. Complications have rarely been reported in the literature. The authors present a case in which the patient suffered a fatal subarachnoid hemorrhage (SAH) after endoscopic third Ventriculostomy. This 63-year-old man presented with confusion and drowsiness and was admitted in to the hospital in poor general condition. Computerized tomography scanning revealed an obstructive hydrocephalus caused by a tumor located in the cerebellopontine angle. An endoscopic third Ventriculostomy was performed with the aid of a Fogarty balloon catheter. Some hours postoperatively, the patient became comatose. Computerized tomography scanning revealed a severe perimesencephalic-peripontine SAH and progressive hydrocephalus. Despite emergency external ventricular drainage, the patient died a few hours later. Although endoscopic third Ventriculostomy is considered to be a simple and safe procedure, one should be aware that severe and sometimes fatal complications may occur. To avoid vascular injury, perforation of the floor of the third ventricle should be performed in the midline, halfway between the infundibular recess and the mamillary bodies, just behind the dorsum sellae.
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...
Michel Zerah - 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.
