Endoscopic third ventriculostomy versus ventriculoperitoneal shunt in the treatment of obstructive hydrocephalus due to posterior fossa tumors in children.
Summary of "Endoscopic third ventriculostomy versus ventriculoperitoneal shunt in the treatment of obstructive hydrocephalus due to posterior fossa tumors in children."
OBJECT:
This study compares endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunt (VPS) in the treatment of pediatric patients with marked obstructive hydrocephalus due to midline posterior fossa tumors.
METHODS:
Fifty-three pediatric patients with a midline posterior fossa tumor (32 medulloblastomas and 21 ependymomas) associated with marked hydrocephalus were studied. Patients were divided into two groups: group A (32 patients) operated by ETV with a mean follow-up of 27.4 months and group B (21 patients) operated by VPS with a mean follow-up of 25 months.
RESULTS:
Both procedures proved to be effective clinically and radiologically. In group A, intraoperative bleeding occurred in two cases (6.2%) and cerebrospinal fluid leakage in one case (3.1%). In group B, shunt infection occurred in two cases (9.4%), one of these two cases died 4.5 months postoperatively from ventriculitis. Subdural collection occurred in two cases (9.4%), epidural hematoma in one case (4.7%), and upward brain herniation in one case (4.7%). Endoscopic third ventriculostomy proved to be superior due to shorter duration of surgery (15 min versus 35 min), lower incidence of morbidity (9.3% versus 38%), no mortality (0% versus 4.7%), and lower incidence of procedure failure (6.2% versus 38%).
CONCLUSION:
The shorter duration of surgery, the lower incidence of morbidity, the absence of mortality, the lower incidence of procedure failure, and the significant advantage of not becoming shunt dependent make ETV be recommended as the first choice in the treatment of pediatric patients with marked obstructive hydrocephalus due to midline posterior fossa tumors.
Affiliation
Department of Neurosurgery, Faculty of Medicine, Cairo University, 81 Nasr Road, Nasr City, Cairo, Egypt, elghandour@yahoo.com.
Journal Details
This article was published in the following journal.
Name: Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
ISSN: 1433-0350
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/20737274
- DOI: http://dx.doi.org/10.1007/s00381-010-1263-2
Medical and Biotech [MESH] Definitions
Ventriculoperitoneal Shunt
Surgical creation of a communication between a cerebral ventricle and the peritoneum by means of a plastic tube to permit drainage of cerebrospinal fluid for relief of hydrocephalus. (From Dorland, 28th ed)
Endolymphatic Shunt
Surgical fistulization of the membranous labyrinth of the inner ear with mastoid, subarachnoid or cochlear shunt. This procedure is used in the treatment of MENIERE DISEASE.
Sphincterotomy, Endoscopic
Incision of Oddi's sphincter or Vater's ampulla performed by inserting a sphincterotome through an endoscope (DUODENOSCOPE) often following retrograde cholangiography (CHOLANGIOPANCREATOGRAPHY, ENDOSCOPIC RETROGRADE). Endoscopic treatment by sphincterotomy is the preferred method of treatment for patients with retained or recurrent bile duct stones post-cholecystectomy, and for poor-surgical-risk patients that have the gallbladder still present.
Portasystemic Shunt, Surgical
Surgical venous shunt between the portal and systemic circulation to effect decompression of the portal circulation. It is performed primarily in the treatment of bleeding esophageal varices resulting from portal hypertension. Types of shunt include portacaval, splenorenal, mesocaval, splenocaval, left gastric-caval (coronary-caval), portarenal, umbilicorenal, and umbilicocaval.
Portacaval Shunt, Surgical
Surgical portasystemic shunt between the portal vein and inferior vena cava.
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