Document Detail


Routine placement of a ventricular reservoir at endoscopic third ventriculostomy.
MedLine Citation:
PMID:  12823877     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Endoscopic third ventriculostomy (ETV) failure may be abrupt in onset, causing a potentially life-threatening increase in intracranial pressure. ETV failure may also have a more insidious onset, and in these cases, diagnosis on clinical and radiological grounds can be difficult. This study evaluates the usefulness of routine ventricular reservoir placement at the time of ETV for subsequent emergency ventricular access or the diagnosis of ETV failure. METHODS: A retrospective review of 84 consecutive patients undergoing ETV with routine insertion of a ventricular reservoir during a 4-year period (1996-2000) was undertaken. The mean follow-up period was 14.8 months. End points for ETV failure were shunt insertion or revision of ETV. The diagnostic and therapeutic use of the reservoir was quantified. RESULTS: The reservoir was used in 32% of patients (n = 27). The reservoir allowed life-saving emergency ventricular access in two cases of acute recurrent hydrocephalus. In patients with symptoms but equivocal radiological evidence of recurrent hydrocephalus, the reservoir allowed for assessment of intracranial pressure (n = 19) and/or a therapeutic trial of cerebrospinal fluid aspiration (n = 5). Seven of these patients subsequently required revision ETV or shunt insertion. In the 14 patients who had normal intracranial pressure, conservative management was successful. The reservoir also facilitated intrathecal drug administration for postoperative ventriculitis (n = 2). No patients requested reservoir removal. CONCLUSION: Routine insertion of a ventricular reservoir allows life-saving emergency therapeutic cerebrospinal fluid aspiration to be performed for sudden neurological deterioration caused by ventriculostomy failure. It also assists in the diagnosis of ETV failure and allows intrathecal drug administration.
Authors:
Kristian Aquilina; Richard J Edwards; Ian K Pople
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  53     ISSN:  0148-396X     ISO Abbreviation:  Neurosurgery     Publication Date:  2003 Jul 
Date Detail:
Created Date:  2003-06-25     Completed Date:  2003-09-04     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  91-6; discussion 96-7     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, Frenchay Hospital, Bristol, England.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Catheters, Indwelling / adverse effects*
Child
Child, Preschool
Endoscopy / adverse effects*
Female
Follow-Up Studies
Humans
Hydrocephalus / physiopathology,  radiography,  surgery*
Infant
Infant, Newborn
Intracranial Pressure / physiology
Male
Middle Aged
Outcome Assessment (Health Care)*
Postoperative Complications*
Recurrence
Retrospective Studies
Treatment Failure
Ventriculostomy / adverse effects*

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


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