Third ventriculostomy vs ventriculoperitoneal shunt in pediatric obstructive hydrocephalus: results from a Swiss series and literature review.

Department of Neurosurgery, CHUV, Lausanne, Switzerland.
Child s Nervous System (Impact Factor: 1.16). 06/2007; 23(5):527-33. DOI: 10.1007/s00381-006-0283-4
Source: PubMed

ABSTRACT Few series compare endoscopic third ventriculostomies (ETV) and ventriculoperitoneal shunts (VPS). To avoid the complications after a shunt insertion, there is an increased tendency to perform a third ventriculostomy. We reviewed all pediatric patients operated in the French-speaking part of Switzerland for a newly diagnosed obstructive hydrocephalus since 1992 and compared the outcome of patients who benefited from ETV to the outcome of patients who benefited from VPS. There were 24 ETV and 31 VPS.
At 5 years of follow-up, the failure rate of ETV was 26%, as compared to 42% for the VPS group. This trend is also found in the pediatric series published since 1990 (27 peer-reviewed articles analyzed).
In accordance to this trend, although a statistical difference cannot be assessed, we believe that ETV should be the procedure of choice in pediatric obstructive hydrocephalus.

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    ABSTRACT: Endoscopic third ventriculostomy (ETV) is an accepted modality of treatment for obstructive hydrocephalus, with good results in adult patients. However in the pediatric age group results vary from poor to similar to the adult population. This study evaluates the outcome of ETV in congenital hydrocephalus of both early and delayed presentation, and investigates factors that determine the outcome. Patients with congenital hydrocephalus who underwent ETV between January 2006 and December 2011 were retrospectively analyzed. Any conditions potentially influencing the need for redo surgery (persistent cerebrospinal fluid [CSF] leak not responding to local measures, tense fontanelle, increased ventricular size, recurrence of symptoms or radiological evidence of failure) were analyzed. A total of 102 patients with a mean age of 7.45 years were included. Presenting features were increasing head circumference and delayed milestones. Ninety-eight patients had triventricular hydrocephalus due to aqueductal stenosis. Procedures performed were ETV only (n = 74), ETV with aqueductoplasty (n = 22), ETV with cystoventriculostomy (n = 2) and aqueductoplasty only (n = 2). Failure of ETV occurred in 11 patients and all were managed with a ventriculoperitoneal shunt. CSF leak in the perioperative period was the only factor that was significantly associated with failure of ETV. ETV is a safe procedure with a good success rate and can be offered to children with aqueductal stenosis. There is a higher chance of failure if there is a CSF leak in the early or late postoperative period.
    Journal of Clinical Neuroscience 09/2014; · 1.32 Impact Factor
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    ABSTRACT: Introduction: Hydrocephalus is the most common congenital abnormality of the central nervous system in infants. Many cases of hydrocephalic children are described since ancient times. It is characterized by excessive accumulation of cerebrospinal fluid in the ventricles of the brain. Its symptomatology during infanthood or early childhood is characterized by swelling of the head, protrusion of the forehead and brain atrophy. All these symptoms appear due to increased cerebrospinal fluid volume, increased intracranial pressure and dilatation of the ventricular walls. Aim: The aim of this paper is to describe the ventriculoperitoneal shunt complications in pediatrics patients and to point out the role of nursing stuff in the prevention of them. Methods: This include literature search on the database Medline and relevant with that issue international hydrocephalus organizations to identify studies regarding the complications of ventriculoperitoneal shunt and the nursing care for each complication. Results: Ventriculoperitoneal shunt is the treatment of hydrocephalic infants, rather than endoscopic third ventriculostomy. Although the success of the ventriculoperitoneal shunt's placement, the patients usually suffer from its afterwards complications. The complications involves postoperative shunt infection, shunt placement failure, shunt obstruction – malfunction, abdominal complications – peritonitis, valve complications, slit-ventricle syndrome and seizures. The role of the nursing stuff is vital, particularly in the postoperative weeks. Conclusion: A proper nursing assessment includes valid identification of complications and their prompt treatment. Also, nurses had to implement accurate nursing care, in order to prevent any complication. Finally, parental teaching from the nurses is crucial in the process of health outcomes for pediatric patient.
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    ABSTRACT: 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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