Document Detail

Failed endoscopic third ventriculostomy in children: management options.
MedLine Citation:
PMID:  12422045     Owner:  NLM     Status:  MEDLINE    
Endoscopic third ventriculostomy (ETV) for obstructive hydrocephalus has a failure rate of 20-50% in various series. The present study analyzes ETV failures in 72 patients over a 2-year period and attempts to outline a management plan. Of the 72 patients who underwent ETV, it failed in 13. Seven of these failures occurred within 1 month, and in 5 others, ETV failed after 1-2 months. Another patient had a delayed failure 2 years after the initial surgery. Upon clinical failure, MRI scans were performed in all patients using either T2 fast spin echo or two-dimensional phase contrast MRI techniques. Of these, no flow could be demonstrated in 12 patients, whereas in 1 patient, good flow was observed. Endoscopic exploration was undertaken in the 12 patients in whom flow could not be demonstrated. Of the 12 who underwent endoscopic exploration, a patent stoma was observed in 7, necessitating insertion of a ventriculoperitoneal shunt (VPS). In the other 5, the stoma had closed by gliosis and a repeat ETV was performed. In 3 of these patients, in addition to the ETV, a VPS was also inserted in accordance with the family's wishes. VPS insertion was carried out in the patient with suggestion of good flow through the stoma. In failed ETV, MRI with flow studies is essential to identify the possible cause of failure. Endoscopic exploration is indicated for patients with no evidence of flow. A repeat ETV is indicated in patients with a closed stoma. Patients with a patent stoma could require insertion of a cerebrospinal fluid shunt.
Aaron Mohanty; M K Vasudev; S Sampath; S Radhesh; V R Sastry Kolluri
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Pediatric neurosurgery     Volume:  37     ISSN:  1016-2291     ISO Abbreviation:  Pediatr Neurosurg     Publication Date:  2002 Dec 
Date Detail:
Created Date:  2002-11-07     Completed Date:  2003-03-25     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9114967     Medline TA:  Pediatr Neurosurg     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  304-9     Citation Subset:  IM    
Copyright Information:
Copyright 2002 S. Karger AG, Basel
Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India.
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MeSH Terms
Cerebrospinal Fluid / physiology
Gliosis / complications
Hydrocephalus / surgery*
Third Ventricle / surgery*
Time Factors
Treatment Failure
Treatment Outcome
Ventriculoperitoneal Shunt
Ventriculostomy / adverse effects*,  methods

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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