Articles: third-ventricle-surgery.
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Clin Neurol Neurosurg · Dec 2015
Supracerebellar infratentorial approach with paramedian expansion for posterior third ventricular and pineal region lesions.
Surgical treatment for lesions in the posterior third ventricle is technically challenging. Surgical approaches to this area carries a risk of both venous and neural injury, with subsequent morbidity. Several approaches are used to reach the pineal region. The supracerebellar infratentorial approach is the commonly approach used for such lesions. ⋯ The paramedian expansion offers a better lateral and inferior tumor resection and a better view of the contralateral extension within the posterior third ventricle. Collicular lesions are better controlled using this approach by gentle inferior and lateral retraction of the cerebellum. The expanded supracerebellar infratentorial approach allows for working on the lateral tumor extension without jeopardizing the deep venous system.
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Journal of neurosurgery · Dec 2015
Long-term results of endoscopic third ventriculostomy: an outcome analysis.
Endoscopic third ventriculostomy (ETV) is the procedure of choice in the treatment of obstructive hydrocephalus. The excellent clinical and radiological success rates are well known. Nevertheless, very few papers have addressed the very long term outcomes of the procedure in very large series. The authors present a large case series of 113 patients who underwent 126 ETVs, and they highlight the initial postoperative outcome after 3 months and long-term follow-up with an average of 7 years. ⋯ The high clinical success rate in short-term and long-term follow-up confirms ETV's status as the gold standard for the treatment of obstructive hydrocephalus, especially for distinct pathologies. The patient's age and underlying pathology may influence the outcome. These factors should be considered carefully preoperatively by the surgeon.
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Journal of neurosurgery · Dec 2015
Observational StudyPredicting success of endoscopic third ventriculostomy: validation of the ETV Success Score in a mixed population of adult and pediatric patients.
Endoscopic third ventriculostomy (ETV) has become the first line of treatment in obstructive hydrocephalus. The Toronto group (Kulkarni et al.) developed the ETV Success Score (ETVSS) to predict the clinical response following ETV based on age, previous shunt, and cause of hydrocephalus in a pediatric population. However, the use of the ETVSS has not been validated for a population comprising adults. The objective of this study was to validate the ETVSS in a "closed-skull" population, including patients 2 years of age and older. ⋯ The ETVSS did not show adequate discrimination but demonstrated excellent calibration in this population of patients 2 years and older. According to decision-curve analyses, the ETVSS is marginally useful in clinical scenarios in which 60% or 70% success rates are the thresholds for preferring ETV to CSF shunt. Previous history of CSF shunt and age were not associated with worse outcomes, whereas posthemorrhagic and postinfectious causes of the hydrocephalus were significantly associated with reduced success rates following ETV.
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Virchow Robin spaces (VRSs) are perivascular spaces that act as drainage pathways for interstitial fluid. Dilatation of VRSs is visible on magnetic resonance images in asymptomatic individuals. However, giant dilatation of VRSs (dVRSs) is very rare. Such giant dVRSs may produce a pressure effect on surrounding structures and can be confused with more sinister conditions such as cystic neoplasm. ⋯ Dilatation of VRS may produce multicystic giant lesions that can easily be confused with other pathologic condition that have a completely different prognosis and management. Knowledge about the existence of such an entity and their radiologic features is important to prevent such misdiagnosis and mismanagement in the form of biopsy/excision, which can have devastating consequences.
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Shunt-related procedures in the treatment of hydrocephalus are often associated with malfunction and revision resulting in significant patient morbidity and financial impact on the health care system. The increased utilization of endoscopic third ventriculostomy (ETV) as an alternative treatment paradigm for obstructive hydrocephalus carries the theoretical expectation of concomitant decreased numbers of shunt procedures. The objective of the present study was to determine the impact of ETV on shunt-related procedures within a 14-year interval (1998-2011), during which ETV has gained wider acceptance and greater utilization. ⋯ Based on prior cost-effectiveness analyses, the observed trend of the inverse correlation between ETVs and shunt-related procedures may contribute to financial savings and improvement in patient outcomes. Further study is required to define the impact on morbidity and associated success rates.