Long-term change in ventricular size following endoscopic third ventriculostomy for hydrocephalus due to tectal plate gliomas.

OBJECT Endoscopic third ventriculostomy (ETV) is an alternative to shunt placement in children with hydrocephalus due to tectal plate gliomas (TPGs). However, controversy remains regarding the amount of ventricular size reduction that should be expected after ETV. This study investigates ventricular size change after ETV for TPGs. METHODS Twenty-two children were identified from a 15-year retrospective database of neuroendoscopic procedures performed at the authors' institution, Children's Hospital of Alabama, in patients with a minimum of 1 year of follow-up. Clinical outcomes, including the need for further CSF diversion and symptom resolution, were recorded. The frontal and occipital horn ratio (FOR) was measured on pre- and postoperative, 1-year, and last follow-up imaging studies. RESULTS In 17 (77%) of 22 children no additional procedure for CSF diversion was required. Of those in whom CSF diversion failed, 4 underwent successful repeat ETV and 1 required shunt replacement. Therefore, in 21 (96%) of 22 patients, CSF diversion was accomplished with ETV. Preoperative and postoperative imaging was available for 18 (82%) of 22 patients. The FOR decreased in 89% of children who underwent ETV. The FOR progressively decreased 1.7%, 11.2%, and 12.7% on the initial postoperative, 1-year, and last follow-up images, respectively. The mean radiological follow-up duration for 18 patients was 5.4 years. When ETV failed, the FOR increased at the time of failure in all patients. Failure occurred 1.6 years after initial ETV on average. The mean clinical follow-up period for all 22 patients was 5.3 years. In all cases clinical improvement was demonstrated at the last follow-up. CONCLUSIONS Endoscopic third ventriculostomy successfully treated hydrocephalus in the extended follow-up period of patients with TPGs. The most significant reduction in ventricular size was observed at the the 1-year followup, with only modest reduction thereafter.

[1]  Muhammad Usman,et al.  Endoscopic third ventriculostomy for obstructive hydrocephalus. , 2010 .

[2]  Shlomi Constantini,et al.  Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus. , 2009, The Journal of pediatrics.

[3]  J. Martín-Vallejo,et al.  Changes in ventricular size after endoscopic third ventriculostomy , 2008, Acta Neurochirurgica.

[4]  J. Landeiro,et al.  Tectal plate tumors. , 2006, Arquivos de neuro-psiquiatria.

[5]  S. Puget,et al.  Tectal plate lesions in children. , 2006, Journal of neurosurgery.

[6]  Núria Bargalló,et al.  Functional analysis of third ventriculostomy patency by quantification of CSF stroke volume by using cine phase-contrast MR imaging. , 2005, AJNR. American journal of neuroradiology.

[7]  H. Mehdorn,et al.  Management of tectal glioma in childhood. , 2005, Pediatric neurology.

[8]  Khan W. Li,et al.  Endoscopic third ventriculostomy for hydrocephalus associated with tectal gliomas. , 2005, Neurosurgical focus.

[9]  D. Honorato,et al.  Intrinsic tectal low grade astrocytomas: is surgical removal an alternative treatment? Long-term outcome of eight cases. , 2005, Arquivos de neuro-psiquiatria.

[10]  M. Javadpour,et al.  The role of neuroendoscopy in the management of tectal gliomas , 2004, Child's Nervous System.

[11]  S. Sgouros,et al.  Changes in ventricular volume in hydrocephalic children following successful endoscopic third ventriculostomy , 2004, Child's Nervous System.

[12]  D. Katz.  Yeh DD, Warnick RE, Ernst RJ. Management strategy for adult patients with dorsal midbrain gliomas. , 2003 .

[13]  N. Akalan,et al.  Tectal Gliomas in Children: The Implications for Natural History and Management Strategy , 2003, Pediatric Neurosurgery.

[14]  R. Tubbs,et al.  Long-term Control of Hydrocephalus via Endoscopic Third Ventriculostomy in Children with Tectal Plate Gliomas , 2002, Neurosurgery.

[15]  David D. Yeh,et al.  Management Strategy for Adult Patients with Dorsal Midbrain Gliomas , 2002, Neurosurgery.

[16]  M. Vloeberghs,et al.  Changes in third ventricular size with neuroendoscopic third ventriculostomy: a blinded study , 2002, Journal of neurology, neurosurgery, and psychiatry.

[17]  J. Drake,et al.  Imaging correlates of successful endoscopic third ventriculostomy. , 2000, Journal of neurosurgery.

[18]  E. Melhem,et al.  Tectal Gliomas: Natural History of an Indolent Lesion in Pediatric Patients , 2000, Pediatric Neurosurgery.

[19]  M. Berger,et al.  Management of Intrinsic Gliomas of the Tectal Plate in Children , 1999, Pediatric Neurosurgery.

[20]  R. Goodman,et al.  Ventricular volume following third ventriculostomy. , 1999, Journal of neurosurgery.

[21]  J. Drake,et al.  Frontal and Occipital Horn Ratio: A Linear Estimate of Ventricular Size for Multiple Imaging Modalities in Pediatric Hydrocephalus , 1998, Pediatric Neurosurgery.

[22]  P. Barnes,et al.  Tectal tumors of childhood: clinical and imaging follow-up. , 1998, AJNR. American journal of neuroradiology.

[23]  L. Goumnerova,et al.  Treatment of hydrocephalus with third ventriculocisternostomy: outcome and CSF flow patterns. , 1997, Pediatric neurosurgery.

[24]  S. Blaser,et al.  Benign intrinsic tectal "tumors" in children. , 1991, Journal of neurosurgery.

[25]  P. Vorkapic,et al.  Microsurgery of midbrain lesions. , 1990, Neurosurgery.

[26]  R. Sanford,et al.  Pencil gliomas of the aqueduct of Sylvius. Report of two cases. , 1982, Journal of neurosurgery.

[27]  F. Roux,et al.  Endoscopic third ventriculostomy: outcome analysis in 368 procedures. , 2010, Journal of neurosurgery. Pediatrics.

[28]  C. Mottolese,et al.  Tectal plate gliomas part II: CT scans and MR imaging of tectal gliomas , 2005, Acta Neurochirurgica.

[29]  C. Mottolese,et al.  Tectal plate gliomas. Part I: Microsurgery of the tectal plate gliomas , 2005, Acta Neurochirurgica.

[30]  Y. Nimura,et al.  Right Ventricular Growth in a Case of Pulmonic Stenosis with Intact Ventricular Septum and Hypoplastic Right Ventricle , 2005 .

[31]  H. Konno,et al.  A case of quadrigeminal hamartoma , 2004, Acta Neuropathologica.

[32]  Jeffrey M. Liebmann,et al.  a ten year review , 1998 .