Tag: Endoscopic third ventriculostomy (ETV)

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Longstanding overt ventriculomegaly in adults (LOVA) with patent aqueduct

Acta Neurochirurgica (2021) 163:3343–3352

Longstanding overt ventriculomegaly in adults (LOVA) represents a form of chronic adulthood hydrocephalus with symptomatic manifestation in late adulthood. Based on the patency of the aqueduct, two different subcohorts of LOVA can be distinguished. Surgical treatments of this condition are also debated. Therefore, we analyzed preoperative characteristics and clinical outcome after different surgical treatments in a subgroup of LOVA patients with a patent aqueduct.

Methods Eighteen LOVA patients with a patent aqueduct consecutively treated at our institution between July 2013 and December 2019 were analyzed for this study. Median age was 70 years. Preoperative radiological and clinical features, surgical procedures (ventriculo-peritoneal shunt or endoscopic third ventriculostomy), and outcomes were collected. Successful outcome was qualitatively defined as an improvement or a halt of progression of the presenting symptoms at follow-up, and quantitatively by changes in mRS and iNPHGS scales.

Results Twelve patients underwent an ETV as a primary treatment, while 6 underwent VPS. A total of 22.2% of them were lost to follow-up. Median follow-up time was 38 months. Six patients (66.7%) in the ETV cohort achieved a successful outcome after treatment, with a complication rate of 11.1%. Two patients underwent rescue VPS after ETV failure with a good outcome. Four patients (100%) underwent primary VPS and achieved a satisfactory outcome after treatment, with a reported complications rate of 25%.

Conclusion LOVA with patent aqueduct represents, in our opinion, a distinct clinical form of chronic hydrocephalus. For this subgroup, as well as for other forms of LOVA, ETV remains an acceptable first-line treatment option considering the good results, and the low complication rate, obtained in those patients and the hypothesis that hydrocephalus is due to an “intracisternal” obstruction.

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Is endoscopic third ventriculostomy superior to shunts in patients with non-communicating hydrocephalus?

ETV

Acta Neurochir (2013) 155:883–889

Endoscopic third ventriculostomy (ETV) and shunts are both utilized in the treatment of noncommunicating hydrocephalus. The objective of this study was to review the evidence comparing the effectiveness of these two techniques.

Methods The Cochrane Central Register of Controlled Trials (CENTRAL) and Medline databases were searched between 1990 and August 2012. We included all studies comparing the failure rate of patients with noncommunicating hydrocephalus treated with ETVand shunts. Two authors (HJM and FTR) appraised quality and extracted data independently.

Results Of 313 articles identified, 12 were selected for further review. Of these, 6 were included for qualitative analysis, and 5 for quantitative analysis (n=504). ETV was associated with a non-statistically significant reduction in failure using the random-effects model (OR 0.58, 95 % CI 0.29-1.13).

Conclusions Both ETV and shunts are associated with a relatively high failure rate. At present there is insufficient proof to unequivocally recommend one mode of treatment above the other. However, there is some evidence that ETV may confer long-term survival advantage over shunts in the treatment of non-communicating hydrocephalus, particularly in patients with certain aetiologies such as aqueductal stenosis. Prospective randomized controlled trials are currently underway and may provide more robust evidence to answer this important question and better guide future management.

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