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Clinical Research
DOI: 10.1016/j.neucie.2021.04.002
Available online 10 April 2021
Re-Do endoscopic third ventriculostomy. Retrospective analysis of 13 patients
Re-ventriculostomía endoscópica de tercer ventrículo. Análisis retrospectivo de una serie de 13 casos
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Jorge Linares Torres
Corresponding author
jorgelt@me.com

Corresponding author.
, Bienvenido Ros López, Sara Iglesias Moroño, Ángela Ros Sanjuán, Antonio Selfa Rodríguez, Laura Cerro Larrazábal, Julia Casado Ruiz, Miguel Ángel Arráez Sánchez
Servicio de Neurocirugía, Hospital Regional Universitario de Málaga, Málaga, Spain
Received 18 November 2020. Accepted 08 February 2021
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Table 1. Characteristics of patients with failure of first ETV. The 13 patients in whom re-ETV was indicated are compared with the 34 in whom it was not indicated.
Table 2. Characteristics of the 13 re-ETVs classified as successes or failures.
Table 3. Individual characteristics of the 13 cases in which re-ETV was indicated.
Table 4. Prognostic factors for re-ETV success described in the literature.
Table 5. Prognostic factors for re-ETV success in our series.
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Abstract
Objetives

Indication for endoscopic third ventriculostomy (ETV) in the treatment for noncommunicating hydrocephalus is widely accepted. There is controversy regarding the indication of a second procedure (re-ETV) when the first has failed. The objective of this work is to revise ETV failures in a series in which re-ETV was performed and to describe the factors related to its prognosis.

Method

Retrospective study of pediatric patients with ETV failure treated by re-ETV between 2003 and 2018. Gender, age in first and second ETV, time to failure of first ETV, etiology of hydrocephalus, previous presence of shunt, ETV-SS in the first and second ETV, intraoperative findings, success of the second procedure and follow-up were collected. The ETV-SS result was grouped into high (≥ 80), moderate (50−70) or low (≤ 40) scores. Endoscopic procedure failure was considered clinical worsening or the absence of radiological criteria for improvement (reduction in ventricular size or presence of ETV flow artifact in the floor of third ventricle).

Results

Of 97 ETV carried out in this period, 47 failures were registered, with 13 re-ETV performed. Of these, 8 were classified as successful (61.53%). Re-ETV was successful in 4/4 cases in which etiology was tectal tumor or aqueduct stenosis. In the group with a high ETV-SS score there was a higher rate of success (75%) than in the group with a moderate score (40%). 9 patients presented shunt prior to first ETV and in them, success was 66.6% compared to 50% in the group without prior shunt. All re-ETV were performed without complications. In 11 of the 13 procedures a closed stoma was found and the remaining 2 cases, we found a punctate opening. The mean follow-up after re-ETV was 61.23 months.

Conclusion

The selection of patients for re-VET should be cautious. Factors such as age, etiology, and previous shunt (ETV-SS factors) have prognostic influence. However, there are specific factors which indicate favorable prognostic for re-VET such as a longer time to failure of the first procedure, the finding of a closed/punctate stoma or the loss of flow artifact in the follow-up MRI.

Keywords:
Hydrocephalus
Neuroendoscopy
Ventriculostomy
Repeat ventriculostomy
Resumen
Objetivos

La indicación de ventriculostomía endoscópica de tercer ventrículo (VET) en el tratamiento de la hidrocefalia no comunicante está extensamente aceptada. Existe controversia respecto a la indicación de un segundo procedimiento (re-VET) cuando el primero ha fallado. El objetivo de este trabajo es recoger los fallos de VET en una serie propia en los que se realizó re-VET y describir los factores relacionados con su pronóstico.

Método

Estudio retrospectivo de pacientes pediátricos con fallo de VET tratados mediante una re-VET entre 2003 y 2018. Se registró género, edad en primera y segunda VET, tiempo hasta fallo de primera VET, etiología de hidrocefalia, presencia previa de DVP, ETV-SS en primera y segunda VET, hallazgos intraoperatorios, éxito del segundo procedimiento y seguimiento. El resultado de ETV-SS se agrupó en puntuación alta (≥ 80), moderada (50-70) o baja (≤ 40). Se consideró fallo de procedimiento endoscópico el deterioro clínico o la ausencia de criterios radiológicos de mejoría (reducción de tamaño ventricular o presencia de artefacto de flujo de VET en área premamilar).

Resultados

De 97 VET realizadas en este periodo, se registraron 47 fallos, llevándose a cabo 13 re-VET. De ellas, 8 fueron clasificadas como éxito (61,53%). La re-VET fue exitosa en 4/4 casos cuya etiología fue tumoración tectal o estenosis de acueducto. En el grupo de alta puntuación ETV-SS hubo mayor porcentaje de éxito (75%) que en el grupo de moderada puntuación (40%). Nueve pacientes presentaban DVP previa a la primera VET y en ellos, el éxito fue del 66,6% frente al 50% en el grupo sin DVP previa. Todas las re-VET se llevaron a cabo sin complicaciones. En 11 de los 13 procedimientos se encontró una membrana premamilar cerrada y en los 2 casos restantes una apertura puntiforme. El seguimiento medio tras re-VET fue de 61,23 meses.

Conclusión

La re-VET es un procedimiento seguro y con una tasa de éxito del 61,5% en nuestra serie. La selección de pacientes debe ser cautelosa. Factores como edad, etiología y derivación previa (factores del ETV-SS) tienen influencia pronóstica. Sin embargo, existen factores concretos que indican un pronóstico favorable para re-VET, como un mayor tiempo hasta el fallo del primer procedimiento, el hallazgo de estoma cerrado/puntiforme o la pérdida de artefacto de flujo en el seguimiento con RM.

Palabras clave:
Hidrocefalia
Neuroendoscopia
Ventriculostomía
Repetir ventriculostomía

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