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 »  Abstract
 » Introduction
 » Indications
 »  Complications of...
 »  Failed Endoscopi...
 »  Endoscopic Third...
 » Conclusions
 »  References

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TOPIC OF THE ISSUE: REVIEW ARTICLE
Year : 2011  |  Volume : 59  |  Issue : 6  |  Page : 848-854

Endoscopic third ventriculostomy for hydrocephalus: A review of indications, outcomes, and complications


Department of Neurological Sciences, Christian Medical College, Vellore, India

Date of Submission22-Dec-2011
Date of Decision22-Dec-2011
Date of Acceptance23-Dec-2011
Date of Web Publication2-Jan-2012

Correspondence Address:
Vedantam Rajshekhar
Department of Neurological Sciences, Christian Medical College, Vellore - 632 004
India
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DOI: 10.4103/0028-3886.91364

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 » Abstract 

Endoscopic third ventriculostomy (ETV) has been in vogue for the past two decades, as a tool in the armamentarium of the neurosurgeon, for the management of hydrocephalus. Its utility has been proven consistently in congenital / acquired aqueductal stenosis, although the outcomes in communicating hydrocephalus as well as hydrocephalus secondary to other etiologies have not been as impressive. It is a relatively safe procedure with the appropriate selection of patients with a low rate of permanent morbidity. This review aims to define the current indications, management outcomes, and complications of ETV.


Keywords: Endoscopy, hydrocephalus, outcome, shunt


How to cite this article:
Moorthy RK, Rajshekhar V. Endoscopic third ventriculostomy for hydrocephalus: A review of indications, outcomes, and complications. Neurol India 2011;59:848-54

How to cite this URL:
Moorthy RK, Rajshekhar V. Endoscopic third ventriculostomy for hydrocephalus: A review of indications, outcomes, and complications. Neurol India [serial online] 2011 [cited 2014 Aug 23];59:848-54. Available from: http://www.neurologyindia.com/text.asp?2011/59/6/848/91364



 » Introduction Top


An endoscope was first used in neurosurgery in the early 1930s when a ureteroscope was used to coagulate the choroid plexus of the lateral ventricle. Since Dandy's classification of hydrocephalus into communicating and non-communicating types and further refinements of the same, bypass procedures to overcome obstruction of the cerebrospinal fluid (CSF) pathways have been established. Ventriculoperitoneal and ventriculoatrial shunts have played a major role in the successful management of patients with hydrocephalus. Insertion of a shunt is associated with a life-long risk of infection, as it is a foreign body, and despite technological advancements, there is a risk of shunt obstruction as well as overdrainage that can result in significant morbidity, needing frequent shunt revisions. [1],[2],[3],[4] The reported rate of shunt malfunction in the first year of placement is 30%, and thereafter it is about 10% per year. The cumulative risk of infection is about 20% per patient, with most centers reporting rates between 5 to 10%. [1],[3] As an alternative to a shunt, endoscopic third ventriculostomy (ETV) has been in routine neurosurgical practice for the past two decades, with long-term outcomes being reported in the recent literature. To perform an ETV, the third ventricular floor (and the Lillequist membrane) is fenestrated between the mamillary bodies and infundibular recess in the midline, to communicate the ventricular system with the basal cisterns. [1],[2],[3]


 » Indications Top


All patients with obstruction between the third ventricle and the cortical subarachnoid spaces are potential candidates for ETV, while obstruction at the level of the arachnoid villi or the venous flow in the superior sagittal sinus is an absolute contraindication. [4]

Aqueductal stenosis

Endoscopic third ventriculostomy has been most consistently reported to have good outcomes in patients with aqueductal stenosis. This may be congenital or acquired, as in the case of tumors involving the posterior third ventricle and tectal gliomas. [1],[5],[6],[7],[8],[9],[10] It has been reported that preoperative observation of a closed aqueduct is a significant predictor of the success of ETV. [6] The reported success rates for ETV in aqueductal stenosis range from 70% to more than 90% in the long term. [5],[8],[11],[12],[13],[14],[15],[16],[17],[18] Even in infants, those with aqueductal stenosis have higher success rates than those with other etiologies for hydrocephalus. [2],[19] The success rates for ETV in infants with aqueductal stenosis are, however, less than those reported in older children and adults. [2],[7],[19]

Endoscopic third ventriculostomy has been combined with biopsy of the posterior third ventricular and thalamic lesions, thus achieving the goals of cerebrospinal fluid (CSF) diversion, as well as obtaining definitive diagnosis in cases of tumor-related aqueductal stenosis. The opinion is divided on whether ventriculostomy should be performed prior to or after the biopsy of the tumor. [14],[20]

Posterior fossa tumors and cysts with hydrocephalus

Endoscopic third ventriculostomy has been attempted with good success rates ranging up to > 90% in patients with posterior fossa tumors and brain stem gliomas with hydrocephalus. [21],[22],[23],[24] ETV has been of proven value in patients with posterior fossa tumors, who have persistent hydrocephalus after tumor resection. [22] No technical difficulties were encountered in patients with brain stem tumors in one series. [24] However, routine performance of ETV prior to posterior fossa tumor surgery or in postoperative hydrocephalus may not be necessary. [23] Dandy-Walker complex malformations, retrocerebellar cysts, mega cisterna magna, and hydrocephalus secondary to fourth ventricular outlet obstruction have all been managed successfully with ETV, with or without aqueductal stenting, as well as choroid plexus coagulation. [13],[25],[26],[27]

Postinfectious hydrocephalus

Warf et al.[28],[29] have reported the outcomes in a large number of pediatric patients with postinfectious hydrocephalus. The success rates in these patients are lower than in patients with hydrocephalus, due to aqueductal stenosis of non-infectious etiology. In their experience, the success rate in children older than one year of age was 81% in patients with postinfectious hydrocephalus and 91% in non-postinfectious hydrocephalus. The success of ETV in infants with postinfectious hydrocephalus was considerably less at 59%. In their analysis, the presence of obstruction at the level of the aqueduct was associated with higher success rates in infants. The five-year survival post ETV or the shunts performed in infants with postinfectious hydrocephalus was around 70% with about one-third of the survivors having significant disability. [29] The low level of success post ETV in this subgroup of patients is likely to be related to adhesions and scarring in the basal cisterns, secondary to the infection. [30] These patients are also likely to have multiple loculations within the ventricular system, rendering them difficult to treat without shunts.

Tuberculous meningitis with hydrocephalus

Tuberculous meningitis (TBM) is characterized by the presence of exudates in the basal cisterns and the site of obstruction could be at the level of the aqueduct, fourth ventricular outlet or at the basal cisterns. [31],[32],[33],[34],[35],[36],[37] Traditionally, placement of shunts has been the treatment of choice in TBM-related hydrocephalus, but high rates of malfunction necessitating revisions have been reported. [34]

There is a role for ETV in patients who are in the chronic phase of the disease, where hydrocephalus is believed to be due to an aqueductal block on account of a small tuberculoma or ependymitis or fourth ventricular outlet block due to basal exudates, which prevents CSF flow over the cortical surface. [32],[33],[34] In the acute phase of the disease, the presence of inflammation in the ependymal lining, presence of tubercles within the ventricle, as well as the subarachnoid spaces, and the basal exudates render performing ETV technically difficult and decrease the chance of success. During ETV, the basal exudates can be washed out. [35],[36] With adequate medical therapy, the tubercles tend to heal and the basal exudates disappear to a large extent. ETV may be attempted in this phase of the disease rather than in the acute phase. [35],[36],[37] Even in the chronic phase, the third ventricular floor is opaque and thickened, making ETV a technical challenge. The overall success rate for ETV in patients with TBM associated hydrocephalus, as reported in large series, is around 70%. [33],[34],[36] Higher success rates of up to 87% have been reported in well-nourished patients with a thin-to-transparent third ventricular floor, without any exudates in the cisterns. [33],[37] Following ETV, patients in better clinical grades at presentation had better outcomes. [34],[36],[37] In this issue of the Journal, Yadav et al, [37] have concluded that ETV failures in TBM-related hydrocephalus could be managed with serial lumbar punctures and lumboperitoneal shunts. In their series, 58% of the patients improved with ETV alone, while 80% of the patients improved with ETV and lumboperitoneal shunt.

Hydrocephalus associated with myelomeningocoele and  Chiari malformation More Detailss

Hydrocephalus associated with myelomeningocele may be of the obstructive or communicating type. As these patients require treatment in infancy, ETV does not provide as good results as in older patients, with failure rates of up to 50% being reported in patients with myelomeningocoele. [2],[27],[30] However, in a recent series, Warf et al, [38] have demonstrated good outcomes in up to 78% of infants with myelomeningocoele associated hydrocephalus treated with ETV and choroid plexus cauterization. There are reports on the successful management of hydrocephalus associated with occipital encephalocoele with ETV, although there is a chance of delayed failure necessitating shunt placement. [39]

Endoscopic third ventriculostomy remains a viable option in the management of hydrocephalus in patients with Chiari I malformation and syringomyelia, with shunt independence being achieved in up to 94% of the patients and resolution of the syrinx being observed in a significant number of patients. [40],[41] In children with Chiari II malformation, the cause of hydrocephalus is unlikely to have an obstructive etiology and ETV has been proposed to play a very limited role in this indication. [4]

Hydrocephalus secondary to intracerebral / intraventricular hemorrhage

Post hemorrhagic hydrocephalus of prematurity has been reported to have poor outcome with ETV and choroid plexus cauterization, with only 40% of the patients needing no further procedures. Scarring of the prepontine cistern was correlated with poor outcome. [18],[30],[42] It has been suggested that in patients with neonatal intraventricular hemorrhage, the obstruction is likely to be in the basal cisterns and the arachnoid villi, in addition to the aqueduct, rendering them poor candidates for an ETV. [4]

Fukuhara et al.[43] have reported that ETV may not be the optimal treatment option in the long term for patients with hydrocephalus, secondary to aneurysmal subarachnoid hemorrhage (SAH), but may be employed as a temporary intervention during the waiting period for the clearance of aneurysmal SAH. Oertel et al.[44] have reported that ETV may be an alternative to the placement of an external ventricular drain in patients with hydrocephalus secondary to intraparenchymal / intraventricular bleeds. During ETV, intraventricular clots can be evacuated. However, the outcome in these patients may be related to the primary etiology of the hemorrhage and its natural course. Performing ETV with a blurred field of vision in the presence of intraventricular blood and distorted ventricular anatomy can be technically challenging. In this issue of the Journal, Chen et al., from Taiwan, have reported on the endoscopic removal of intraventricular blood in patients with spontaneous intraventricular hemorrhage. They did not perform ETV due to the poor visibility of the third ventricular floor caused by the blood in the CSF. Data on patients in whom this procedure was not performed, such as, in historical controls, has not been provided and no definite conclusion on its benefit can be drawn from their experience. [45]

Shunt dysfunction

Endoscopic third ventriculostomy is an effective option in patients with hydrocephalus who present with shunt dysfunction due to underdrainage or overdrainage. The overall rate of shunt failure in patients shunted during infancy is reported to be 48, 52, and 63% at one, two, and five years, with 20% of the patients having more than three revisions in five years. [3] ETV in patients with shunt dysfunction was successful in about 80% of the patients. [3],[46],[47] Patients with aqueductal stenosis had the best outcome, while postinfectious and myelomeningocele patients had a poor outcome. Ligation of the existing shunt system after ETV has been recommended, as an intermittent or remaining flow of CSF through a malfunctioning shunt could result in decreased flow through the ventriculostomy, predisposing to its closure. [46] Other series have reported that up to 70% of the patients become shunt-free after ETV for shunt dysfunction. [48],[49] Woodworth et al.[50] have reported that after ETV for shunt dysfunction, only 25% remained symptom-free at the two-year follow-up and have suggested ETV combined with concurrent CSF shunting in patients with multiple shunt revisions and complications. In their experience, there was a 2.5 times higher risk of ETV failure when it was performed in patients with prior shunts than when it was performed in shunt naïve patients. A higher rate of procedure-related complications has been reported when ETV is performed in patients with prior shunt placement. [51]

Communicating hydrocephalus

Endoscopic third ventriculostomy has been performed on patients with idiopathic normal pressure hydrocephalus, with reported success rates of 65 to 72%. Patients with gait disturbance as the predominant symptom, age < 65 years, and minimal dementia have shown the highest rates of improvement. This is comparable with the outcome following shunt placement. [52],[53] In a series with pediatric patients, communicating hydrocephalus secondary to meningitis or hemorrhage have been reported to have lower rates of success with ETV, as opposed to children with obstructive hydrocephalus. [30]

Endoscopic third ventriculostomy in patients less than one year of age

Infants presenting with hydrocephalus are not appropriate candidates for ETV as they have poorly developed absorptive surfaces in the subarachnoid spaces and have an open anterior fontanelle, with a soft skull. [4] Nevertheless, ETV has been attempted by several authors in infants with hydrocephalus, due to varying etiologies. Ogiwara et al., [54] reported an overall success rate of 34.8% in infants less than six months of age. Even as success rates have been satisfactory in isolated aqueductal stenosis, there is a high rate of failure with other etiologies as well as in preterm infants. [2],[4],[19],[30],[55],[56],[57],[58],[59],[60] Sukianov et al.,[61] have reported favorable outcomes of up to 75% in children who manifest symptoms of hydrocephalus at more than one month of age and in those with a thinned-out third ventricular floor. Combining choroid plexus cauterization with ETV in infants presenting with hydrocephalus has been reported to improve the success rates from 47% (with ETV alone) to 66%. [62] On analyzing the mechanisms of failure of ETV in infants, an immature CSF absorption capacity in infants, reclosure of the stoma, as well as formation of new arachnoid membranes in the basal cisterns, in the presence of patent stoma, were identified. [4],[63]


 » Complications of Endoscopic Third Ventriculostomy Top


In a review of complications following ETV in 2884 patients, permanent morbidity was 2.38% and permanent neurological complications (hemiparesis, gaze palsy, memory disorders, and altered sensorium) occurred in 1.44%. The overall complication rate was 8.5%. The other complications related to ETV included intraoperative hemorrhage from the ependymal veins, choroid plexus or basilar artery and its branches (3.7%), and permanent diabetes insipidus, weight gain, and precocious puberty. Early postoperative mortality due to sepsis and hemorrhage was 0.21%. [64] Complication rates of around 8 to 9% were reported in other series. [9],[60] Intraoperative complications included intraventricular hemorrhage, cardiovascular changes, such as, bradycardia during fenestration and inflation of the balloon of the Fogarty catheter, and damage to the hypothalamus and fornix. [60] Within the first month following ETV, the complications reported included a CSF leak, ventriculitis, subdural fluid collection, and restenosis of the stoma. [30],[60],[64],[65] The risk of complication was higher with repeat ETV procedures and in patients with prior shunts. [51]

Misplacement of the fenestration in the third ventricular floor usually accounts for most of the intraoperative hemorrhagic as well as cranial nerve-related complications. This can be avoided by recognizing the mamillary bodies, foramen of Monro, infundibular recess, dorsum sellae, and staying in the midline. It is also important to not go ahead with performing the ETV if the anatomy is not suitable. [66]

Bradycardia has been reported in up to 41% of the cases during fenestration of the third ventricular floor and the mechanisms postulated include stimulation of the preoptic area, at which time there may be associated hypotension. Stimulation of the posterior hypothalamus causes tachycardia with hypertension. [60],[67] Use of normal saline instead of Ringer's Lactate for irrigation could reduce the risk of hyperkalemia-induced bradycardia.

Subdural hygromas as well as chronic subdural hematomas have been reported following ETV, attributable to the sudden excessive release of CSF or a large cortical puncture allowing egress of CSF into the subdural space. [60]

In this issue of the Journal, Singh et al., [68] have reported the perioperative complications during neuroendoscopic procedures, including ETV. Tachycardia was the most frequently encountered intraoperative complication, while fever was the most common immediate postoperative complication. Massive intraoperative bleeding was the most serious complication. As their study was a retrospective one, involving patients with varied etiologies, they could only speculate on the causes of the complications and suggest possible preventive measures. [68]


 » Failed Endoscopic Third Ventriculostomy and its Management Top


Endoscopic third ventriculostomy failure occurred, with recurrence of symptoms, in about 10 to 20% of the patients with aqueductal stenosis and in up to 50% of the patients in whom ETV was performed for other indications. In a literature review, the failure rate was reported to range from 8 to 69% (8 to 47% when infants were excluded). [69] It was acknowledged that most ETV failures occurred early within a few days to two weeks following the procedure, with very few failures reported after six months. The cumulative probability of a failure presenting itself during the first 16 days after ETV was found to be 90%. [2],[8],[9],[15],[17],[38],[46],[60],[70] However, there are reports of delayed failures after many months, leading to rapid deterioration and death. [65] The predictors of failure include, age less than one year, with failures being higher in younger infants, posthemorrhagic and postinfectious indications, hydrocephalus with repeated shunt malfunctions, intraoperative recognition of a thickened third ventricular floor, patent aqueduct, scarring within the basal cisterns, and routine placement of external ventricular drains. [6],[30],[50],[54],[60],[70]

When failure of ETV is suspected, cine MR and two millimeter sagittal TSE T2 sequences to detect the flow across the stoma may be performed. [36],[70],[71] In patients with no flow, endoscopic re-exploration may be done to reopen the stoma in cases of closure. In several cases, newly formed arachnoid membranes may be detected and these may have to be reopened. In case the stoma is patent, shunt insertion must be considered. [70] Shunt placement has also been the option when late failures occur. [9] In this issue of the Journal, the role of repeat ETV in patients with closure of a previously performed ETV was analyzed, and poor patient selection was noted to be the most important cause for early failure of ETV. The authors chose to shunt 45 of 51 patients with early ETV failures (within seven days of the ETV), while repeat ETV was performed in 26 of 32 patients, with delayed failure. The success rate of repeat ETV was 50% in the early failure group and 78% in the late failure group, further reiterating that the poor choice of patients in whom ETV was performed initially could contribute to a high rate of initial failures. [72]

Following ETV, the intracranial pressure tends to remain high in a subgroup of patients for up to nine days, while in others it normalizes within 24 hours. These patients have an 'adaptation period' for establishment of flow through the ventriculostomy stoma. Up to three lumbar punctures in the interim period have been recommended to promote flow through the stoma (before terming it as a failure) for ensuring success of the ETV in asymptomatic as well as symptomatic patients. [73],[74],[75] It has also been noted that the CSF absorptive capacity as well as CSF circulation through the subarachnoid spaces shows further improvement only several months following ETV. [74]


 » Endoscopic Third Ventriculostomy Versus Shunt Top


Even as ETV may score over a shunt in terms of: (a) Avoidance of a foreign body implantation, and (b) establishment of 'physiological' CSF circulation, shunts still have a role in the management of hydrocephalus in certain situations, such as, infantile hydrocephalus, particularly in resource-constrained environments. [1],[4],[30],[33],[60],[76] Shunts are technically easier to perform than ETV. The risk of intraoperative complications is slightly higher with ETV than with a shunt. [21],[76] In the long term, shunts have a slightly higher rate of malfunction and infection. In a review of literature, the percentage of pediatric patients who were revision-free following ETV was 52% at two years and 30% at five years compared to 55 and 24% of the patients, following a ventriculoperitoneal shunt. [69] Infective complications in children are significantly lower following ETV vis-à-vis shunts and infections following ETV have a more benign course, being amenable to antibiotic treatment alone. [76] However, the quality of life estimates in children undergoing ETV or shunt, one year following the procedure, have been found to be similar. [77]


 » Conclusions Top


Endoscopic third ventriculostomy has been found to be an effective alternative strategy to shunt placement in obstructive hydrocephalus secondary to aqueductal stenosis, with good long-term results. Use of ETV in other situations must be judicious, with an appropriate review of the patient's ventricular anatomy as well as etiology of the hydrocephalus. Ultimately, the management of hydrocephalus needs to be individualized with both the options of ETV and shunt being appropriate in individual circumstances.

 
 » References Top

1.Sandberg DI. Endoscopic management of hydrocephalus in pediatric patients: A review of indications, techniques and outcomes. J Child Neurol 2008;23:550-60.  Back to cited text no. 1
[PUBMED]  [FULLTEXT]  
2.Fritsch MJ, Kienke S, Ankermann T, Padoin M, Mehdorn HM. Endoscopic third ventriculostomy in infants. J Neurosurg 2005;103(1 Suppl):50-3.  Back to cited text no. 2
    
3.Bilginer B, Oguz KK, Akalan N. Endoscopic third ventriculostomy for malfunction in previously shunted infants. Childs Nerv Syst 2009;25:683-8.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.Rekate HL. Selecting patients for endoscopic third ventriculostomy. Neurosurg Clin N Am 2004;15:39-49.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Wellons JC 3 rd , Tubbs RS, Banks JT, Grabb B, Blount JP, Oakes WJ, et al. Long term control of hydrocephalus via endoscopic third ventriculostomy in children with tectal plate gliomas. Neurosurgery 2002;51:63-7.  Back to cited text no. 5
    
6.Warf BC, Kulkarni AV. Intraoperative assessment of cerebral aqueduct patency and cisternal scarring: impact of success of endoscopic third ventriculostomy in 403 African children. J Neurosurg Pediatr 2010;5:204-9.  Back to cited text no. 6
[PUBMED]  [FULLTEXT]  
7.Singh D, Gupta V, Goyal A, Singh H, Sinha S, Singh AK, et al. Endoscopic third ventriculostomy in obstructed hydrocephalus. Neurol India 2003;51:39-42.  Back to cited text no. 7
[PUBMED]  Medknow Journal  
8.Feng H, Huang G, Liao X, Fu K, Tan H, Pu H, et al. Endoscopic third ventriculostomy in the management of obstructive hydrocephalus: An outcome analysis. J Neurosurg 2004;100:626-33.  Back to cited text no. 8
[PUBMED]  [FULLTEXT]  
9.Santamarta D, Diaz Alvarez A, Goncalves JM, Hernandez J. Outcome of endoscopic third ventriculostomy. Results from an unselected series with noncommunicating hydrocephalus. Acta Neurochir (Wein) 2005;147:377-82.  Back to cited text no. 9
    
10.Li KW, Roonprapunt C, Lawson HC, Abbott IR, Wisoff J, Epstein F, et al. Endoscopic third ventriculostomy for hydrocephalus associated with tectal gliomas. Neurosurg Focus 2005;18:E2.  Back to cited text no. 10
    
11.Ray P, Jallo GI, Kim RY, Kim BS, Wilson S, Kothbauer K, et al. Endoscopic third ventriculostomy for tumor-related hydrocephalus in a pediatric population. Neurosurg Focus 2005;19:E8.  Back to cited text no. 11
    
12.Amini A, Schmidt RH. Endoscopic third ventriculostomy in a series of 36 patients. Neurosurg Focus 2005;19:E9.  Back to cited text no. 12
    
13.Garg A, Suri A, Chandra PS, Kumar R, Sharma BS, Mahapatra AK. Endoscopic third ventriculostomy: 5 years'experience at the All India Institute of Medical Sciences. Pediatr Neurosurg 2009;45;1-5.  Back to cited text no. 13
    
14.Roopesh Kumar SV, Mohanty A, Santosh V, Satish S, Devi BI, Praharaj SS, et al. Endoscopic options in management of posterior third ventricular tumors. Childs Nerv Syst 2007;23:1135-45.  Back to cited text no. 14
[PUBMED]  [FULLTEXT]  
15.Dusick JR, McArthur DL, Bergsneider M. Success and complication rates of endoscopic third ventriculostomy for adult hydrocephalus: A series of 108 patients. Surg Neurol 2008;69:5-15.  Back to cited text no. 15
[PUBMED]  [FULLTEXT]  
16.Gangemi M, Mascari C, Maiuri F, Godano U, Donati P, Longatti PL. Long-term outcome of endoscopic third ventriculostomy in obstructive hydrocephalus. Minim Invasive Neurosurg 2007;50:265-9.  Back to cited text no. 16
[PUBMED]  [FULLTEXT]  
17.Jenkinson MD, Hayhurst C, Al-Jumaily M, Kandasamy J, Clark S, Mallucci CL. The role of endoscopic third ventriculostomy in adult patients with hydrocephalus. J Neurosurg 2009;110:861-6.  Back to cited text no. 17
[PUBMED]  [FULLTEXT]  
18.Sacko O, Boetto S, Lauwers-Cances V, Dupuy M, Roux FE. Endoscopic third ventriculostomy: Outcome analysis in 368 procedures. J Neurosurg Pediatr 2010;5:68-74.  Back to cited text no. 18
[PUBMED]  [FULLTEXT]  
19.Elgamal EA, El-Dawlatly AA, Murshid WR, El-Watidy SM, Jamjoom ZA. Endoscopic third ventriculostomy for hydrocephalus in children younger than 1 year of age. Childs Nerv Syst 2011;27:111-6.  Back to cited text no. 19
[PUBMED]  [FULLTEXT]  
20.Selvapandian S. Endoscopic management of thalamic gliomas. Minim Invasive Neurosurg 2009;49:194-6.  Back to cited text no. 20
    
21.El-Ghandour NM. Endoscopic third ventriculostomy versus ventriculoperitoneal shunt in treatment of obstructive hydrocephalus due to posterior fossa tumors in children. Childs Nerv Syst 2011;27:117-26.  Back to cited text no. 21
[PUBMED]  [FULLTEXT]  
22.Tamburrini G, Pettorini BL, Massimi L, Caldarelli M, Di Rocco C. Endoscopic third ventriculostomy: The best option in the treatment of persistent hydrocephalus after posterior fossa tumor removal? Childs Nerv Syst 2008;24:1405-12.  Back to cited text no. 22
[PUBMED]  [FULLTEXT]  
23.Fritsch MJ, Doerner L, Kienke S, Mehdorn HM. Hydrocephalus in children with posterior fossa tumors: Role of endoscopic third ventriculostomy. J Neurosurg 2005;103(1 Suppl):40-2.  Back to cited text no. 23
    
24.Klimo P Jr, Goumnerova LC. Endoscopic third ventriculocisternostomy for brainstem tumors. J Neurosurg 2006;105(4 Suppl):271-4.  Back to cited text no. 24
    
25.Mohanty A, Biswas A, Satish S, Vollmer DG. Efficacy of endoscopic third ventriculostomy in fourth ventricular outlet obstruction. Neurosurgery 2008;63:905-13.  Back to cited text no. 25
[PUBMED]  [FULLTEXT]  
26.Warf BC, Dewan M, Mugamba J. Management of Dandy-Walker complex-associated infant hydrocephalus by combined endoscopic third ventriculostomy and choroids plexus cauterization. J Neurosurg Pediatr 2011;8:377-83.  Back to cited text no. 26
[PUBMED]  [FULLTEXT]  
27.Mohanty A, Biswas A, Satish S, Praharaj SS, Sastry KV. Treatment options for Dandy-Walker malformation. J Neurosurg 2006;105(5 Suppl):348-56.  Back to cited text no. 27
    
28.Warf BC. Hydrocephalus in Uganda: The predominance of infectious origin and primary management with endoscopic third ventriculostomy. J Neurosurg 2005;102(1 Suppl):1-15.   Back to cited text no. 28
    
29.Warf BC, Dagi AR, Kaaya BN, Schiff SJ. Five-year survival and outcome of treatment for postinfectious hydrocephalus in Ugandan infants. J Neurosurg Pediatr 2011;8:502-8.  Back to cited text no. 29
[PUBMED]  [FULLTEXT]  
30.Drake JM. Canadian Pediatric Neurosurgery study group. Endoscopic third ventriculostomy in pediatric patients: The Canadian experience. Neurosurgery 2007;60:881-6.  Back to cited text no. 30
    
31.Figaji AA, Fieggen AG, Peter JC. Endoscopic third ventriculostomy in tuberculous meningitis. Childs Nerv Syst 2003;19:217-25.  Back to cited text no. 31
[PUBMED]  [FULLTEXT]  
32.Jonathan A, Rajshekhar V. Endoscopic third ventriculostomy for chronic hydrocephalus after tuberculous meningitis. Surg Neurol 2005;63:32-4.  Back to cited text no. 32
[PUBMED]  [FULLTEXT]  
33.Singh D, Sachdev V, Singh AK, Sinha S. Endoscopic third ventriculostomy in post-tuberculous meningitic hydrocephalus: A preliminary report. Minim Invasive Neurosurg 2005;48:47-52.  Back to cited text no. 33
[PUBMED]  [FULLTEXT]  
34.Bhagwati S, Mehta N, Shah S. Use of endoscopic third ventriculostomy in hydrocephalus of tubercular origin. Childs Nerv Syst 2010;26:1675-82.  Back to cited text no. 34
[PUBMED]  [FULLTEXT]  
35.Rajshekhar V. Management of hydrocephalus in patients with tuberculous meningitis. Neurol India 2009;57:368-74.  Back to cited text no. 35
[PUBMED]  Medknow Journal  
36.Chugh A, Husain M, Gupta RK, Ojha BK, Chandra A, Rastogi M. Surgical outcome of tuberculous meningitis hydrocephalus treated by endoscopic third ventriculostomy: Prognostic factors and postoperative neuroimaging for functional assessment of ventriculostomy. J Neurosurg Pediatr 2009;3:371-7.  Back to cited text no. 36
[PUBMED]  [FULLTEXT]  
37.Yadav YR, Parihar V, Agrawal M, Bhatele PR. Endoscopic third ventriculostomy in tubercular meningitis with hydrocephalus. Neurol India 2011;59:855-60  Back to cited text no. 37
    
38.Warf BC, Campbell JW. Combined endoscopic third ventriculostomy and choroid plexus cauterization as primary treatment of hydrocephalus for infants with myelomeningocoele: Long term results of a prospective intent-to-treat study in 115 East African infants. J Neurosurg Pediatr 2008;2:310-6.  Back to cited text no. 38
[PUBMED]  [FULLTEXT]  
39.Moorthy RK, Rajshekhar V. Management of hydrocephalus associated with occipital encephalocoele using endoscopic third ventriculostomy: Report of two cases. Surg Neurol 2002;57:351-5.  Back to cited text no. 39
[PUBMED]  [FULLTEXT]  
40.Hayhurst C, Osman-Farah J, Das K, Mallucci C. Initial management of hydrocephalus associated with Chiari malformation type I-syringomyelia complex via endoscopic third ventriculostomy: An outcome analysis. J Neurosurg 2008;108:1211-4.  Back to cited text no. 40
[PUBMED]  [FULLTEXT]  
41.Mohanty A, Suman R, Shankar SR, Satish S, Praharaj SS. Endoscopic third ventriculostomy in the management of Chiari I malformation and syringomyelia associated with hydrocephalus. Clin Neurol Neurosurg 2005;108:87-92.  Back to cited text no. 41
[PUBMED]  [FULLTEXT]  
42.Warf BC, Campbell JW, Riddle E. Initial experience with combined endoscopic third ventriculostomy and choroid plexus cauterization for post-hemorrhagic hydrocephalus of prematurity: The importance of prepontine cistern status and the predictive value of FIESTA MRI imaging. Childs Nerv Syst 2011;27:1063-71.  Back to cited text no. 42
[PUBMED]  [FULLTEXT]  
43.Fukuhara T, Shimizu T, Namba Y. Limited efficacy of endoscopic third ventriculostomy for hydrocephalus following aneurysmal subarachnoid hemorrhage. Neurol Med Chir (Tokyo) 2009;49:449-55.  Back to cited text no. 43
[PUBMED]  [FULLTEXT]  
44.Oertel JM, Mondorf Y, Baldauf J, Schroeder HW, Gaab MR. Endoscopic third ventriculostomy for obstructive hydrocephalus due to intracranial hemorrhagewith intraventricular extension. J Neurosurg 2009;111:1119-26.  Back to cited text no. 44
[PUBMED]  [FULLTEXT]  
45.Chen HC, Chuang CC, Tzaan WC, Hsu PW. Application of neuroendoscopy in the treatment of obstructive hydrocephalus secondary to hypertensive intraventricular hemorrhage. Neurol India 2011;59:873-78  Back to cited text no. 45
    
46.Baldauf J, Fritsch MJ, Oertel J, Gaab MR, Schroder H. Value of endoscopic third ventriculostomy instead of shunt revision. Minim Invasive Neurosurg 2010;53:159-63.  Back to cited text no. 46
    
47.Boschert J, Hellwig D, Krauss JK. Endoscopic third ventriculostomy for shunt dysfunction in occlusive hydrocephalus: Long term follow up and review. J Neurosurg 2003;98:1032-9.  Back to cited text no. 47
[PUBMED]  [FULLTEXT]  
48.Melikian A, Korshunov A. Endoscopic third ventriculostomy in patients with malfunctioning CSF-shunt. World Neurosurg 2010;74:532-7.  Back to cited text no. 48
[PUBMED]  [FULLTEXT]  
49.Marton E, Feletti A, Basaldella L, Longatti P. Endoscopic third ventriculostomy in previously shunted children: A retrospective study. Childs Nerv Syst 2010;26:937-43.  Back to cited text no. 49
[PUBMED]  [FULLTEXT]  
50.Woodworth G, McGirt MJ, Thomas G, Williams MA, Rigamonti D. Prior CSF shunting increases the risk of endoscopic third ventriculostomy failure in the treatment of obstructive hydrocephalus in adults. Neurol Res 2007;29:27-31.  Back to cited text no. 50
[PUBMED]  [FULLTEXT]  
51.Hader WJ, Walker RL, Myles ST, Hamilton M. Complications of endoscopic third ventriculostomy in previously shunted patients. Neurosurgery 2008;63(Suppl 1):ONS168-74.  Back to cited text no. 51
    
52.Gangemi M, Maiuri F, Buonamassa S, Colella G, de Divitilis E. Endoscopic third ventriculostomy in idiopathic normal pressure hydrocephalus. Neurosurgery 2004;55:129-34.  Back to cited text no. 52
    
53.Hailong F, Guangfu H, Haibin T, Hong P, Yong C, Weidong L. Endoscopic third ventriculostomy in the management of communicating hydrocephalus: A preliminary study. J Neurosurg 2008;109:923-30.  Back to cited text no. 53
    
54.Ogiwara H, Dipatri AJ Jr, Alden TD, Bowman RM, Tomita T. Endoscopic third ventriculostomy for hydrocephalus in children younger than 6 months of age. Childs Nerv Syst 2010;26:343-7.  Back to cited text no. 54
[PUBMED]  [FULLTEXT]  
55.Lipina R, Reguli S, Dolezilova V, Kuncikova M, Podesvova H. Endoscopic third ventriculostomy for obstructive hydrocephalus in children younger than 6 months of age: is it a first-choice method? Childs Nerv Syst 2008; 24:1021-1027.  Back to cited text no. 55
    
56.Warf BC. Comparison of endoscopic third ventriculostomy alone and combined with choroid plexus cauterization in infants younger than 1 year of age: A prospective study in 550 African children. J Neurosurg 2005;103:475-81.  Back to cited text no. 56
[PUBMED]  [FULLTEXT]  
57.Baldauf J, Oertel J, Gaab MR, Schroeder HW. Endoscopic third ventriculostomy in children younger than 2 years of age. Childs Nerv Syst 2007;23:623-6.  Back to cited text no. 57
[PUBMED]  [FULLTEXT]  
58.O'Brien DF, Seghedoni A, Collins DR, Hayhurst C, Mallucci CL. Is there an indication for ETV in young infants in aetiologies other than isolated aqueduct stenosis? Childs Nerv Syst 2006;22:1565-72.  Back to cited text no. 58
[PUBMED]  [FULLTEXT]  
59.Yadav YR, Jaiswal S, Adam N, Basoor A, Jain G. Endoscopic third ventriculostomy in infants. Neurol India 2006; 54:161-3.   Back to cited text no. 59
[PUBMED]  Medknow Journal  
60.Navarro R, Gil-Parra R, Reitman AJ, Olavarria G, Grant JA, Tomita T. Endoscopic third ventriculostomy in children: Early and late complications and their avoidance. Childs Nerv Syst 2006;22:506-13.   Back to cited text no. 60
[PUBMED]  [FULLTEXT]  
61.Sukianov AA, Sufianova GZ, Iakimov IA. Endoscopic third ventriculostomy in patients younger than 2 years: Outcome analysis of 41 hydrocephalus cases. J Neurosurg Pediatr 2010;5:392-401.  Back to cited text no. 61
    
62.Warf BC. Comparison of endoscopic third ventriculostomy alone and combined with choroid plexus cauterization in infants younger than 1 year of age: A prospective study in 550 African children. J Neurosurg 2005;103(6 Suppl):475-81.  Back to cited text no. 62
    
63.Wagner W, Koch D. Mechanisms of failure of endoscopic third ventriculostomy in young infants. J Neurosurg 2005; 103(1 Suppl): 43-49.  Back to cited text no. 63
    
64.Bouras T, Sgouros S. Complications of endoscopic third ventriculostomy. J Neurosurg Pediatr 2011;7:643-9.  Back to cited text no. 64
[PUBMED]  [FULLTEXT]  
65.Ersahin Y, Arsalan D. Complications of endoscopic third ventriculostomy. Childs Nerv Syst 2008;24:943-8.  Back to cited text no. 65
    
66.Schroeder HW, Niendorf WR, Gaab MR. Complications of endoscopic third ventriculostomy. J Neurosurg 2002;96:1032-40.  Back to cited text no. 66
[PUBMED]  [FULLTEXT]  
67.Anandh B, Madhusudan Reddy KR, Mohanty A, Umamaheswara Rao GS, Chandramouli BA. Intraoperative bradycardia and postoperative hyperkalemia in patients undergoing endoscopic third ventriculostomy. Minim Invasive Neurosurg 2002;45:154-7.  Back to cited text no. 67
[PUBMED]  [FULLTEXT]  
68.Singh GP, Prahakar H, Bithal PK, Dash HH. A retrospective analysis of perioperative complications during intracranial neuroendoscopic procedures: Our institutional experience. Neurol India 2011;59:861-65.   Back to cited text no. 68
    
69.De Ribaupierre S, Rilliet B, Vernet O, Regli L, Villemure JG. Third ventriculostomy vs ventriculoperitoneal shunt in pediatric obstructive hydrocephalus: Results from a swill series and literature review. Childs Nerv Syst 2007;23:527-33.  Back to cited text no. 69
[PUBMED]  [FULLTEXT]  
70.Mohanty A, Vasudev MK, Sampath S, Radhesh S, Sastry Kolluri VR. Failed endoscopic third ventriculostomy in children: Management options. Pediatr Neurosurg 2002;37:304-9.   Back to cited text no. 70
[PUBMED]  [FULLTEXT]  
71.Dincer A, Vildiz E, Kohan S, Ozek MM. Analysis of endoscopic third ventriculostomy patency by MRI: Value of different pulse sequences, the sequence parameters, and imaging planes for investigation of flow void. Childs Nerv Syst 2011;27:127-35.  Back to cited text no. 71
    
72.Mahapatra A, Mehr S, Singh D, Tandon M, Ganjoo P, Singh H. Ostomy closure and the role of repeat endoscopic third ventriculostomy (re-ETV) in failed ETV procedures. Neurol India 2011;59:867-73  Back to cited text no. 72
    
73.Santamarta D, Martin-Vallejo J. Evolution of intracranial pressure during the immediate postoperative period after endoscopic third ventriculostomy. Acta Neurochir Suppl 2005;95:213-7.  Back to cited text no. 73
[PUBMED]    
74.Nishiyama K, Mori H, Tanaka R. Changes in CSF hydrodynamics following endoscopic third ventriculostomy for shunt-dependent noncommunicating hydrocephalus. J Neurosurg 2003;98:1027-31.  Back to cited text no. 74
[PUBMED]  [FULLTEXT]  
75.Cinalli G, Spennato P, Ruggiero C, Aliberti F, Zerah M, Trischitta V, et al. Intracranial pressure monitoring and lumbar puncture after endoscopic third ventriculostomy in children. Neurosurgery 2006;58:126-36.  Back to cited text no. 75
[PUBMED]  [FULLTEXT]  
76.Di Rocco C, Massini L, Tamburrini G. Shunts vs endoscopic third ventriculostomy in infants: Are there different types and / or rates of complications? Childs Nerv Syst 2006;22:1573-89.  Back to cited text no. 76
    
77.Drake JM, Kulkarni AV, Kestle J. Endoscopic third ventriculostomy versus ventriculoperitoneal shunt in pediatric patients: A decision analysis. Childs Nerv Syst 2009;25;467-72.  Back to cited text no. 77
    



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