Skip to main content

Advertisement

SpringerLink
Log in

Complications of endoscopic third ventriculostomy

  • Original Paper
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Objects

Although endoscopic third ventriculostomy (ETV) is considered as the first choice in the management of noncommunicating hydrocephalus, it is not without risk or complication.

Methods

The patients who had undergone ETV only between 1998 and 2005 were retrospectively reviewed. There were 85 males and 70 females, and 173 ETVs were performed in 155 patients. The patients’ age ranged from 2 months to 77 years. Complications were categorized as (1) intraoperative, (2) early postoperative (<1 month), and (3) late postoperative (>1 month). Follow-up of the patients ranged from 1 to 86 months.

Results

Overall complication rate per patient was 15.4%, and complication per procedure was 18%. Complication rate significantly varied with the etiology of hydrocephalus (P = 0.013). The patients with Chiari type I malformation and tumor had no or very low complication rates. The complication risk was significantly higher in repeat endoscopic procedure (55.5%) than in the first procedure (10%; P = 0.0001).

Conclusion

ETV should be the first choice in the management of noncommunicating hydrocephalus. Training, experience, and meticulous technique will decrease the complication rate. Patients undergoing ETV should be followed in a similar manner to patients with cerebrospinal fluid shunts.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Abtin K, Thompson BG, Walker ML (1998) Basilar artery perforation as a complication of endoscopic third ventriculostomy. Pediatr Neurosurg 28:35–41

    Article  PubMed  CAS  Google Scholar 

  2. Anandh B, Madhusudan Reddy KR, Mohanty A, Umamaheswara Rao GS, Chandramouli BA (2002) Intraoperative bradycardia and postoperative hyperkalemia in patients undergoing endoscopic third ventriculostomy. Minim Invasive Neurosurg 45:154–157

    Article  PubMed  CAS  Google Scholar 

  3. Beems T, Grotenhuis JA (2004) Long-term complications and definition of failure of neuroendoscopic procedures. Child Nerv Syst 20:868–877

    Article  Google Scholar 

  4. Bellotti A, Rapana A, Iaccarino C, Schonauer M (2001) Intracranial pressure monitoring after endoscopic third ventriculostomy: an effective method to manage the ‘adaptation period’. Clin Neurol Neurosurg 103:223–227

    Article  PubMed  CAS  Google Scholar 

  5. Benabarre A, Ibanez J, Boget T, Obiols J, Martinez-Aran A, Vieta E (2001) Neuropsychological and psychiatric complications in endoscopic third ventriculostomy: a clinical case report. J Neurol Neurosurg Psychiatry 71:268–271

    Article  PubMed  CAS  Google Scholar 

  6. Beni-Adani L, Siomin V, Segev Y, Beni S, Constantini S (2000) Increasing chronic subdural hematoma after endoscopic iii ventriculostomy. Child Nerv Syst 16:402–405

    Article  CAS  Google Scholar 

  7. Bonanni R, Carlesimo GA, Caltagirone C (2004) Amnesia following endoscopic third ventriculostomy: a single case study. Eur Neurol 51:118–120

    Article  PubMed  Google Scholar 

  8. Brockmeyer D, Abtin K, Carey L, Walker ML (1998) Endoscopic third ventriculostomy: an outcome analysis. Pediatr Neurosurg 28:236–240

    Article  PubMed  CAS  Google Scholar 

  9. Buxton N, Ho KJ, Macarthur D, Vloeberghs M, Robertson I (2001) Neuroendoscopic third ventriculostomy for hydrocephalus in adults: report of a single unit’s experience with 63 cases. Surg Neurol 55:74–78

    Article  PubMed  CAS  Google Scholar 

  10. Buxton N, Punt J (2000) Cerebral infarction after neuroendoscopic third ventriculostomy: case report. Neurosurgery 46:999–1002

    Article  PubMed  CAS  Google Scholar 

  11. Choi JU, Kim DS, Kim SH (1999) Endoscopic surgery for obstructive hydrocephalus. Yonsei Med J 40:600–607

    PubMed  CAS  Google Scholar 

  12. Cinalli G, Salazar C, Mallucci C, Yada JZ, Zerah M, Sainte-Rose C (1998) The role of endoscopic third ventriculostomy in the management of shunt malfunction. Neurosurgery 43:1323–1327

    Article  PubMed  CAS  Google Scholar 

  13. Cinalli G, Spennato P, Ruggiero C, Aliberti F, Trischitta V, Buonocore MC, Cianciulli E, Maggi G (2007) Complications following endoscopic intracranial procedures in children. Child Nerv Syst 23:633–644

    Article  Google Scholar 

  14. Derbent A, Erşahin Y, Yurtseven T, Turhan T (2006) Hemodynamic and electrolyte changes in patients undergoing neuroendoscopic procedures. Child Nerv Syst 22:253–257

    Article  Google Scholar 

  15. Di Rocco C, Massimi L, Tamburrini G (2006) Shunts vs endoscopic third ventriculostomy in infants: are there different types and/or rates of complications? A review. Child Nerv Syst 22:1573–1589

    Article  Google Scholar 

  16. Drake J, Chumas P, Kestle J, Pierre-Kahn A, Vinchon M, Brown J, Pollack IF, Arai H (2006) Late rapid deterioration after endoscopic third ventriculostomy: additional cases and review of the literature. J Neurosurg 105(2 Suppl):118–126

    PubMed  Google Scholar 

  17. Drake JM (2007) Endoscopic third ventriculostomy in pediatric patients: the Canadian experience. Neurosurgery 60:881–886

    Article  PubMed  Google Scholar 

  18. Edwards RJ, Dirks PB (2006) Gelfoam obstruction of endoscopic third ventriculostomy. Case illustration. J Neurosurg 105(2 Suppl):154

    PubMed  Google Scholar 

  19. El-Dawlatly AA, Murshid WR, Elshimy A, Magboul MA, Samarkandi A, Takrouri MS (2000) The incidence of bradycardia during endoscopic third ventriculostomy. Anesth Analg 91:1142–1144

    Article  PubMed  CAS  Google Scholar 

  20. Feng H, Huang G, Liao X, Fu K, Tan H, Pu H, Cheng Y, Liu W, Zhao D (2004) Endoscopic third ventriculostomy in the management of obstructive hydrocephalus: an outcome analysis. J Neurosurg 100:626–633

    PubMed  Google Scholar 

  21. Ferrer E, Santamarta D, Garcia-Fructuoso G, Caral L, Rumià J (1997) Neuroendoscopic management of pineal region tumours. Acta Neurochir (Wien) 139:12–21

    Article  CAS  Google Scholar 

  22. Fukuhara T, Namba Y, Kuyama H (2004) Ventricular reservoir migration into the lateral ventricle through the endoscopic tract after unsuccessful third ventriculostomy. Pediatr Neurosurg 40:186–189

    Article  PubMed  Google Scholar 

  23. Fukuhara T, Vorster SJ, Luciano MG (2000) Risk factors for failure of endoscopic third ventriculostomy for obstructive hydrocephalus. Neurosurgery 46:1100–1111

    Article  PubMed  CAS  Google Scholar 

  24. Hader WJ, Drake J, Cochrane D, Sparrow O, Johnson ES, Kestle J (2002) Death after late failure of third ventriculostomy in children. Report of three cases. J Neurosurg 97:211–215

    PubMed  Google Scholar 

  25. Handler MH, Abbott R, Lee M (2004) A near-fatal complication of endoscopic third ventriculostomy: case report. Neurosurgery 35:525–527

    Article  Google Scholar 

  26. Harter DH, Swanger R, Tenner M (2004) Growing burr hole: enlarging pseudomeningocele at the site of a craniostomy. Child Nerv Syst 20:127–130

    Article  Google Scholar 

  27. Hellwig D, Grotenhuis JA, Tirakotai W, Riegel T, Schulte DM, Bauer BL, Bertalanffy H (2005) Endoscopic third ventriculostomy for obstructive hydrocephalus. Neurosurg Rev 28:1–34

    Article  PubMed  Google Scholar 

  28. Hopf NJ, Grunert P, Fries G, Resch KDM, Perneczky A (1999) Endoscopic third ventriculostomy: outcome analysis of 100 consecutive procedures. Neurosurgery 44:795–806

    Article  PubMed  CAS  Google Scholar 

  29. Horowitz M, Albright AL, Jungreis C, Levy EI, Stevenson K (2001) Endovascular management of a basilar artery false aneurysm secondary to endoscopic third ventriculostomy: case report. Neurosurgery 49:1461–1464

    Article  PubMed  CAS  Google Scholar 

  30. Husain M, Jha D, Vatsal DK, Thaman D, Gupta A, Husain N, Gupta RK (2003) Neuro-endoscopic surgery–experience and outcome analysis of 102 consecutive procedures in a busy neurosurgical centre of India. Acta Neurochir (Wien) 145:369–375

    CAS  Google Scholar 

  31. Javadpour M, May P, Mallucci C (2003) Sudden death secondary to delayed closure of endoscopic third ventriculostomy. Br J Neurosurg 17:266–269

    Article  PubMed  CAS  Google Scholar 

  32. Kamel MH, Murphy M, Aquilina K, Marks C (2006) Subdural haemorrhage following endoscopic third ventriculostomy. A rare complication. Acta Neurochir (Wien).148:591–593

    Google Scholar 

  33. Kehler U, Gliemroth J, Knopp U, Arnold H (1998) The role of third ventriculostomy in previously shunted hydrocephalus. In: Hellwig D, Bauer BL (eds) Minimally invasive techniques for neurosurgery. Springer, Berlin, pp 77–80

    Google Scholar 

  34. Kim BS, Jallo GI, Kothbauer K, Abbott IR (2004) Chronic subdural hematoma as a complication of endoscopic third ventriculostomy. Surg Neurol 62:64–68

    Article  PubMed  Google Scholar 

  35. Koizumi H, Fukamachi A, Nukui H (1987) Postoperative subdural fluid collections in neurosurgery. Surg Neurol 27:147–153

    Article  PubMed  CAS  Google Scholar 

  36. Kombogiorgas D, Sgouros S (2006) Assessment of the influence of operative factors in the success of endoscopic third ventriculostomy in children. Child Nerv Syst 22:1256–1262

    Article  CAS  Google Scholar 

  37. Kramer U, Kanner AA, Siomin V, Harel S, Constantini S (2001) No evidence of epilepsy following endoscopic third ventriculostomy: a short-term follow-up. Pediatr Neurosurg 34:121–123

    Article  PubMed  CAS  Google Scholar 

  38. Kurschel S, Ono S, Oi S (2007) Risk reduction of subdural collections following endoscopic third ventriculostomy. Child Nerv Syst 23:521–526

    Article  Google Scholar 

  39. Lenthall LK, Cinalli G, Rodesch G, Lasjaunias PL (1999) Endovascular management of a traumatic basilar tip aneurysm following endoscopic ventriculostomy in a child. Interv Neuroradiol 5:57–60

    Google Scholar 

  40. Lipina R, Palecek T, Reguli S, Kovarova M (2007) Death in consequence of late failure of endoscopic third ventriculostomy. Child Nerv Syst 23:815–819

    Article  Google Scholar 

  41. Maeda Y, Inamura T, Morioka T, Muratani H, Fukui M (2000) Hemorrhagic subdural effusion complicating an endoscopic III ventriculostomy. Child Nerv Syst 16:312–314

    Article  CAS  Google Scholar 

  42. McLaughlin MR, Wahlig JB, Kaufmann AM, Albright AL (1997) Traumatic basilar aneurysm after third ventriculostomy: case report. Neurosurgery 41(6):1400–1403

    Article  PubMed  CAS  Google Scholar 

  43. Mobbs RJ, Vonau M, Davies MA (2003) Death after late failure of endoscopic third ventriculostomy: a potential solution. Neurosurgery 53:384–385

    Article  PubMed  Google Scholar 

  44. Mohanty A, Anandh M, Reddy S, Sastry KVR (1997) Contralateral massive acute subdural collection after endoscopic third ventriculostomy—a case report. Minim Invas Neurosurg 40:59–61

    CAS  Google Scholar 

  45. Navarro R, Gil-Parra R, Reitman AJ, Olavarria G, Grant JA, Tomita T (2006) Endoscopic third ventriculostomy in children: early and late complications and their avoidance. Child Nerv Syst 22:506–513

    Article  Google Scholar 

  46. Nishiyama K, Mori H, Tanaka R (2003) Changes in cerebrospinal fluid hydrodynamics following endoscopic third ventriculostomy for shunt-dependent noncommunicating hydrocephalus. J Neurosurg 98:1027–1031

    Article  PubMed  Google Scholar 

  47. Peretta P, Ragazzi P, Galarza M, Mussa F, Cinalli G (2006) Complications and pitfalls of neuroendoscopic surgery in children. J Neurosurg 105(3 Suppl):187–193 Pediatrics

    PubMed  Google Scholar 

  48. Rohde V, Gilsbach JM (2000) Anomalies and variants of the endoscopic anatomy for third ventriculostomy. Minim Invasive Neurosurg 43:111–117

    Article  PubMed  CAS  Google Scholar 

  49. Ruggiero C, Cinalli G, Spennato P, Aliberti F, Cianciulli E, Trischitta V, Maggi G (2004) Endoscopic third ventriculostomy in the treatment of hydrocephalus in posterior fossa tumors in children. Child Nerv Syst 20:828–833

    Article  Google Scholar 

  50. Schmidt RH (1999) Use of a microvascular Doppler probe to avoid basilar artery injury during endoscopic third ventriculostomy: technical note. J Neurosurg 90:156–159

    PubMed  CAS  Google Scholar 

  51. Schonauer C, Bellotti A, Tessitore E, Parlato C, Moraci A (2000) Traumatic subependymal hematoma during endoscopic third ventriculostomy in a patient with a third ventricle tumor: case report. Minim Invasive Neurosurg 43:135–137

    Article  PubMed  CAS  Google Scholar 

  52. Schroeder HW, Niendorf WR, Gaab MR (2002) Complications of endoscopic third ventriculostomy. J Neurosurg 96:1032–1040

    PubMed  Google Scholar 

  53. Schroeder HW, Warzok RW, Assaf JA, Gaab MR (1999) Fatal subarachnoid hemorrhage after endoscopic third ventriculostomy. J Neurosurg 90:153–155

    PubMed  CAS  Google Scholar 

  54. Sgaramella E, Castelli G, Sotgiu S (2004) Chronic subdural collection after endoscopic third ventriculostomy. Acta Neurochir (Wien) 146:529–530

    Article  CAS  Google Scholar 

  55. Sgaramella E, Sotgiu S, Crotti F (2003) Overdrainage after endoscopic third ventriculostomy: an unusual case of chronic subdural haematoma—case report and review of the literature. Minim Invas Neurosurg 46:354–356

    Article  CAS  Google Scholar 

  56. Siomin V, Weiner H, Wisoff J, Cinalli G, Pierre-Kahn A, Saint-Rose C, Abbott R, Elran H, Beni-Adani L, Ouaknine G, Constantini S (2001) Repeat endoscopic third ventriculostomy: is it worth trying. Child Nerv Syst 17:551–555

    Article  CAS  Google Scholar 

  57. Teo C, Rahman S, Boop FA, Cherny B (1996) Complications of endoscopic neurosurgery. Child’s Nerv Syst 12:248–253

    Article  CAS  Google Scholar 

  58. Teo C (2004) Complications of endoscopic third ventriculostomy. In: Cinalli G, Maixner WJ, Sainte-Rose C (eds) Pediatric Hydrocephalus. Springer, Milan, pp 411–420

    Google Scholar 

  59. Thomson S, Tyagi AK, Chumas PD (2003) Intracranial hypertrophic calcification complicating neuroendoscopy. Report of three cases. J Neurosurg 98:186–189

    PubMed  Google Scholar 

  60. Tuli S, Alshail E, Drake J (1999) Third ventriculostomy versus cerebrospinal fluid shunt as a first procedure in pediatric hydrocephalus. Pediatr Neurosurg 30:11–15

    Article  PubMed  CAS  Google Scholar 

  61. Vaicys C, Fried A (2000) Transient hyponatriemia complicated by seizures after endoscopic third ventriculostomy. Minim Invasive Neurosurg 43:190–191

    Article  PubMed  CAS  Google Scholar 

  62. van Aalst J, Beuls EA, van Nie FA, Vles JS, Cornips EM (2002) Acute distortion of the anatomy of the third ventricle during third ventriculostomy. Report of four cases. J Neurosurg 96:597–599

    PubMed  Google Scholar 

  63. van Aken J, Struys M, Verplancke T, de Baerdemaeker L, Caemaert J, Mortier E (2003) Cardiovascular changes during endoscopic third ventriculostomy. Minim Invasive Neurosurg 46:198–201

    Article  PubMed  Google Scholar 

  64. Vandertop PW (1998) Traumatic basilar aneurysm after third ventriculostomy: case report. Neurosurgery 43:647–648

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Pediatric Neurosurgery, Ege University Faculty of Medicine, 35100, Bornova, Izmir, Turkey

    Yusuf Erşahin & Dilek Arslan

Authors
  1. Yusuf Erşahin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dilek Arslan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yusuf Erşahin.

Additional information

Presented at the Fourth World Conference of the International Study Group of Neuroendoscopy, 9–12 May 2007, Paris, France.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Erşahin, Y., Arslan, D. Complications of endoscopic third ventriculostomy. Childs Nerv Syst 24, 943–948 (2008). https://doi.org/10.1007/s00381-008-0589-5

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-008-0589-5

Keywords

Search

Navigation