Skip to main content

Advertisement

SpringerLink
Log in

Role of endoscopic third ventriculostomy in patients with communicating hydrocephalus: an evaluation by MR ventriculography

  • Original Article
  • Published:
Neurosurgical Review Aims and scope Submit manuscript

Abstract

Post-tubercular meningitic hydrocephalus (TBMH) and post-traumatic hydrocephalus (PTH) is often considered a contraindication for endoscopic third ventriculostomy (ETV), as it is mostly of communicating type in these cases. The aim of the present study was to define the role of ETV in patients with communicating hydrocephalus. Ten consecutive patients of TBMH, PTH and postneurocysticercus (NCC) hydrocephalus were formed the study group. Diagnosis of communicating hydrocephalus was made using magnetic resonance ventriculography (MRV). If contrast was seen coming out from the ventricular system into the basal cisterns, it was considered as communicating hydrocephalus. Patients with clinical and imaging evidence of raised intracranial pressure and failed medical treatment were taken up for ETV. All patients were studied by preoperative and postoperative MRV. Success of the procedure was assessed by the improvement in clinical and imaging parameters on postprocedure follow-up in all these cases. Technically successful ETV was performed in all 10 patients. Overall success rate of ETV in communicating hydrocephalus was 70% (n = 7). The shunt surgery was performed in the remaining three patients with ETV failure. One patient developed complication following postoperative MRV and was managed conservatively. We conclude that ETV is effective in post-TBM, post-traumatic communicating and post-NCC communicating hydrocephalus and should be considered as initial surgical option for cerebrospinal fluid diversion in these patients. MRV is a relatively safe technique to ascertain the patency of subarachnoid space as well as ETV stoma.

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.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Aquilina K, Edwards RJ, Pople IK (2003) Routine placement of a ventricular reservoir at endoscopic third ventriculostomy. Neurosurgery 53:91–97

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  3. Cinalli G (1999) Alternatives to shunting. Childs Nerv Syst 15:718–731

    Article  PubMed  CAS  Google Scholar 

  4. Cinalli G, Sainte-Rose C, Chumas P, Zerah M, Brunelle F, Lot G, Pierre-Kahn A, Renier D (1999) Failure of third ventriculostomy in the treatment of aqueductal stenosis in children. J Neurosurg 90(3):448–454

    PubMed  CAS  Google Scholar 

  5. Figaji AA, Fieggen AG, Peter JC (2003) Endoscopic third ventriculostomy in tuberculous meningitis. Childs Nerv Syst 19:217–225

    Article  PubMed  CAS  Google Scholar 

  6. Figaji AA, Fieggen AG, Peter JC (2005) Air encephalography for hydrocephalus in the era of neuroendoscopy. Childs Nerv Syst 21:559–565

    Article  PubMed  CAS  Google Scholar 

  7. Foroutan M, Mafee MF, Dujovny M (1998) Third ventriculostomy, phase-contrast cine MRI and endoscopic techniques. Neurol Res 20(5):443–448

    PubMed  CAS  Google Scholar 

  8. Frim DM, Goumnerova LC (1997) Telemetric intraventricular pressure measurements after third ventriculocisternostomy in a patient with non communicating hydrocephalus. Neurosurgery 41:1425–1428

    Article  PubMed  CAS  Google Scholar 

  9. 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 

  10. Fukuhara T, Vorster SJ, Ruggieri P, Luciano MG (1999) Third ventriculostomy patency: comparison of findings at cine phase-contrast MR imaging and at direct exploration. AJNR Am J Neuroradiol 20:1560–1566

    PubMed  CAS  Google Scholar 

  11. Gangemi M, Maiuri F, Buonamassa S, Colella G, de Divitiis E (2004) Endoscopic third ventriculostomy in idiopathic normal pressure hydrocephalus. Neurosurgery 55:129–134

    Article  PubMed  Google Scholar 

  12. Goumnerova LC, Frim DM (1997) Treatment of hydrocephalus with third ventriculocisternostomy: outcome and CSF flow pattern. Pediatr Neurosurg 27:149–152

    Article  PubMed  CAS  Google Scholar 

  13. Govindappa SS, Narayanan JP, Krishnamoorthy VM, Shastry CH, Balasubramaniam A, Krishna SS (2000) Improved detection of intraventricular cysticercal cysts with the use of three-dimensional constructive interference in steady state MR sequences. AJNR Am J Neuroradiol 21:679–684

    PubMed  CAS  Google Scholar 

  14. Greitz D (2004) Radiological assessment of hydrocephalus: new theories and implications for therapy. Neurosurg Rev 27(3):145–165

    Article  PubMed  Google Scholar 

  15. Greitz D (2007) Paradigm shift in hydrocephalus research in legacy of Dandy's pioneering work: rationale for third ventriculostomy in communicating hydrocephalus. Childs Nerv Syst 23:487–489

    Article  PubMed  Google Scholar 

  16. Greitz D, Hannerz J (1996) A proposed model of cerebrospinal fluid circulation: observations with radionuclide cisternography. Am J Neuroradiol 17:431–438

    PubMed  CAS  Google Scholar 

  17. Hirsch JF, Hirsch E, Sainte-Rose C, Renier D, Pierre-Kahn A (1986) Stenosis of the aqueduct of Sylvius: aetiology and treatment. J Neurosurg Sci 30:29–39

    PubMed  CAS  Google Scholar 

  18. Hopf NJ, Grunert P, Fries G, Resch KDM, Perneczky A (1999) Endoscopic third ventriculostomy: outcome analysis of 100 consecutive patients. Neurosurgery 44(4):795–803

    Article  PubMed  CAS  Google Scholar 

  19. Husain M, Jha D, Rastogi M, Husain N, Gupta RK (2005) Role of neuroendoscopy in the management of patients with tuberculous meningitis hydrocephalus. Neurosurg Rev 56:278–283

    Article  Google Scholar 

  20. Husain M, Jha D, Thaman D, Husain N, Gupta RK (2004) Ventriculostomy in a tumor involving the third ventricular floor. Neurosurg Rev 27(1):70–72

    Article  PubMed  Google Scholar 

  21. Husain M, Jha D, Vatsal DK, Thaman D, Gupta A, Husain N, Gupta RK (2003) Neuroendoscopic surgery—experience and outcome analysis of 102 consecutive procedures in a busy neurosurgical centre of India. Acta Neurochir (Wien) 145(5):369–376

    CAS  Google Scholar 

  22. Jack CR Jr, Kelly PJ (1989) Stereotactic third ventriculostomy: assessment of patency with MR imaging. AJNR Am J Neuroradiol 10:515–522

    PubMed  Google Scholar 

  23. Jones RF, Kwock BC, Stening WA, Vonau M (1994) The current status of endoscopic third ventriculostomy in the management of non-communicating hydrocephalus. Minim Invasive Neurosurg 37:28–36

    PubMed  CAS  Google Scholar 

  24. Jones RF, Stening WA, Brydon M (1990) Endosopic third ventriculostomy. Neurosurgery 26:86–92

    Article  PubMed  CAS  Google Scholar 

  25. Joseph VB, Raghuram L, Korah IP, Chacko AG (2003) MR Ventriculography for the study of CSF flow. AJNR Am J Neuroradiol 24:373–381

    PubMed  Google Scholar 

  26. Kunz U, Goldman A, Barder C, Waldbaur H, Oldenkott P (1994) Endoscopic fenestration of the third ventricular floor in aqueductal stenosis. Minim Invasive Neurosurg 1975:42–47

    Google Scholar 

  27. Lev S, Bhadelia RA, Estin D, Heilman CB, Wolpert SM (1997) Functional analysis of third ventriculostomy patency with phase-contrast MRI velocity measurements. Neuroradiology 39:175–179

    Article  PubMed  CAS  Google Scholar 

  28. Mitchell P, Mathew B (1999) Third ventriculostomy in normal pressure hydrocephalus. Br J Neurosurg 13:382–385

    Article  PubMed  CAS  Google Scholar 

  29. Mohanty A, Vasudev MK, Sampath S, Radhesh S, Kolluri VRS (2002) Failed Endoscopic Third Ventriculostomy in Children: Management Options. Pediatr Neurosurg 37:304–309

    Article  PubMed  Google Scholar 

  30. Oka K, Yamamoto M, Ikeda K, Tomonaga M (1993) Flexible endoneurosurgical therapy for aqueductal stenosis. Neurosurgery 33:236–242

    Article  PubMed  CAS  Google Scholar 

  31. Rapana A, Bellotti A, Iaccarino C, Pascale M, Schonauer M (2004) Intracranial pressure patterns after endoscopic third ventriculostomy preliminary experience. Acta Neurochir (Wien) 146:1309–1315

    Article  CAS  Google Scholar 

  32. Ray DE, Cavanagh JB, Nolan CC, Williams SCR (1996) Neurotoxic effects of gadopentetate dimeglumine: behavioural disturbance and morphology after intracerebroventricular injection in rats. Am J Neuroradiol 17:365–373

    PubMed  CAS  Google Scholar 

  33. Scarrow AM, Levy EI, Pascucci L, Albright AL (2000) Outcome analysis of endoscopic III ventriculostomy. Childs Nerv Syst 16:442–445

    Article  PubMed  CAS  Google Scholar 

  34. Schwartz TH, Yoon SS, Cutruzzola FW, Goodman RR (1996) Third ventriculostomy: postoperative ventricular size and outcome. Minim Invasive Neurosurg 39(4):122–129

    PubMed  CAS  Google Scholar 

  35. Siebner HR, Grafin von Einsiedel H, Conrad B (1997) Magnetic resonance ventriculography with gadolinium DTPA: report of two cases. Neuroradiology 39:418–422

    Article  PubMed  CAS  Google Scholar 

  36. Singh D, Sachdev V, Singh AK, Sinha S (2005) Endosopic third ventriculostomy in post-tubercular meningitic hydrocephalus: a preliminary report. Minim Invasive Neurosurg 48:47–52

    Article  PubMed  CAS  Google Scholar 

  37. Siomin V, Cinalli G, Grotenhuis A, Golash A, Oi S, Kothbauer K, Weiner H, Roth J, Beni-Adani L, Pierre-Kahn A, Takahashi Y, Mallucci C, Abbott R, Wisoff J, Constantini S (2002) Endoscopic third ventriculostomy in patients with cerebrospinal fluid infection and/or hemorrhage. J Neurosurg 97:519–524

    Article  PubMed  Google Scholar 

  38. Skalpe IO, Tang GJ (1997) Magnetic resonance imaging contrast media in the subarachnoid space: a comparison between gadodiamide injection and gadopentetate dimeglumine in an experimental study in pigs. Invest Radiol 32:140–148

    Article  PubMed  CAS  Google Scholar 

  39. Smyth MD, Tubbs RS, Wellons JC III, Oakes WJ, Blount JP, Grabb PA (2003) Endoscopic third ventriculostomy for hydrocephalus secondary to central nervous system infection or intraventricular haemorrhage in children. Pediatr Neurosurg 39:258–263

    Article  PubMed  Google Scholar 

  40. Turgut Tali E, Ercan N, Krumina G, Rudwan M, Mironov A, Yu Zeng Q, Jinkins JR (2002) Intrathecal gadolinium (gadopentetate dimeglumine) enhanced magnetic resonance myelography and cisternography: results of a multicenter study. Invest Radiol 37:152–159

    Article  PubMed  Google Scholar 

  41. Zeng Q, Xiong L, Jinkins JR, Fan Z, Liu Z (1999) Intrathecal gadolinium-enhanced MR myelography and cisternography: a pilot study in human patients. AJR Am J Roentgenol 173:1109–1115

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, King George’s Medical University, Lucknow, UP, India

    Ishwar Singh, Mazhar Husain & Manu Rastogi

  2. Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareily Road, Lucknow, UP, India, 226014

    Mohammad Haris & Rakesh K. Gupta

  3. Department of Pathology, King George’s Medical University, Lucknow, UP, India

    Nuzhat Husain

Authors
  1. Ishwar Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mohammad Haris
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mazhar Husain
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nuzhat Husain
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Manu Rastogi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rakesh K. Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rakesh K. Gupta.

Additional information

Comments

Nikolai Hopf, Stuttgart, Germany

The authors describe 10 patients with communicating hydrocephalus treated by endoscopic third ventriculostomy (ETV). Communicating hydrocephalus was caused by trauma, tubercular meningitis or neurocysticercosis.

All patients had MR ventriculography before and after ETV. Seven patients were treated successfully, based on clinical findings and MRI. The others show nicely the usefulness of MR-ventriculography for indication and outcome of ETV, even though their technique of performing it under general anesthesia and repetitive puncturing of the ventricle via the same burr hole seams associated with an additional risk of infection and not applicable to a large patient population. But it is certainly a very valuable investigation in patients with not accepted indication for ETV or nonconclusive MRI findings.

My concern with this paper is the definition of communicating hydrocephalus. The others define it by MR ventriculography when the contrast medium exits the fourth ventricle but stays in the cisterns of the posterior fossa. Patients with further spread of the contrast were excluded (two patients).

In all treated patients (10 patients), CSF did obviously not reach the region of CSF reabsorption. Therefore this type of hydrocephalus should be categorized as noncommunicating. It is well-known that ETV is successful whenever a formerly nonexisting access to the convexity can be created and reabsorption is not impaired. However the paper most importantly demonstrates that patients with posttraumatic, postmeningitic, and hydrocephalus from neurocysticercosis may profit from ETV, if an obstruction of the CSF pathway is present. This can nicely be demonstrated by MR ventriculography. But it is certainly not correct, based on this paper, to conclude that communicating hydrocephalus can be treated successfully by ETV.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Singh, I., Haris, M., Husain, M. et al. Role of endoscopic third ventriculostomy in patients with communicating hydrocephalus: an evaluation by MR ventriculography. Neurosurg Rev 31, 319–325 (2008). https://doi.org/10.1007/s10143-008-0137-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10143-008-0137-5

Keywords

Search

Navigation