PEDİATRİK YAŞ GRUBUNDA ENDOSKOPİK ÜÇÜNCÜ VENTRİKÜLOSTOMİ YAPILAN HASTALARIN RETROSPEKTİF ANALİZİ

Abstract

Amaç: Hidrosefali ameliyatlarında ventrikülo-peritoneal (V/P) şant ve endoskopik üçüncü ventrikülostomi (EÜV) sıklıkla tercih edilen cerrahilerdir. Çalışmamızda 17 yaş altında EÜV yapılan hastaların yaş ve cinsiyete göre dağılımlarını, cerrahi komplikasyonlarını ve V/P şant ihtiyaçlarının incelenmesi amaçlanmıştır. Gereç ve Yöntem: Ocak 2015-Haziran 2022 tarihleri arasında İstanbul Üniversitesi İstanbul Tıp Fakültesi, Beyin ve Sinir Cerrahisi Anabilim Dalı’nda 17 yaş altında EÜV ameliyatı yapılan 44 hasta çalışmaya dahil edilmiştir. Hastaların klinik ve radyolojik sonuçları retrospektif olarak değerlendirilmiştir. Bulgular: Endoskopik üçüncü ventrikülostomi yapılan hastaların 24’ü kadın (%54,5), 20’si erkekti (%45,4). Hastaların ortalama yaşları 7,3 idi. En sık hastaneye başvuru şikâyetleri 11 hastada saptanan (%25) baş ağrısı ve 10 hastada saptanan(%22,7) baş çevresinde artıştı. İncelenen hastalar arasında hidrosefalinin en yaygın nedeni intrakraniyal tümördü (%34). Daha önce V/P şant operasyonu yapılan ve takiplerinde şant disfonksiyonu gelişen beş (%11,3) hastaya EÜV yapıldı. EÜV yapılmış 44 hastanın 30’unda (%68,1) hidrosefalinin gerilediği görülürken, 14 hasta (%31,8) ikinci kez opere edilerek V/P şant takıldı. EÜV sonrası ikinci kez opere edilerek V/P şant takılan 14 hastanın 7’sine (%50) ilk ayda, 4’üne (%28,5) ise EÜV sonrası 1-3 aylık süreçte V/P şant takıldı. EÜV yapılan hastaların beşinde (%11,3) postoperatif yara yeri problemi geliştiği görüldü. Sonuç: Geleneksel şant cerrahisine kıyasla EÜV komplikasyon riskinin daha düşük olması ve operasyon sonrası yaşam kalitesini arttırması gibi birçok avantaj sunar. Çocuklarda ETV'nin başarısı çeşitli faktörlerden etkilenebilmesine rağmen prosedürün birçok pediatrik hastada güvenli ve etkili olduğu gösterilmiştir.

Keywords

• Hidrosefali
• endoskopik üçüncü ventrikülostomi
• ventriküloperitoneal şant

RETROSPECTIVE ANALYSIS OF PEDIATRIC HYDROCEPHALUS PATIENTS TREATED WITH ENDOSCOPIC THIRD VENTRICULOSTOMY

Abstract

Objective: Ventriculoperitoneal (VP) shunt and endoscopic third ventriculostomy (ETV) are commonly utilized surgical interventions for managing hydrocephalus. This study aimed to analyze ETV procedures performed on patients under 17 years of age, focusing on demographic factors such as age and gender, etiological considerations, surgical complications, and the necessity for VP shunt placement. Material and Method: A retrospective review was conducted on pediatric patients who underwent ETV for hydrocephalus at the Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, spanning from January 2015 to June 2022. The study encompassed 44 patients aged 17 years or younger, with assessments made retrospectively based on clinical and radiological outcomes. Result: Among the 44 patients subjected to ETV for hydrocephalus, 24 were female (54.5%) and 20 were male (45.4%), with a mean age of 7.3 years. The most prevalent presenting symptom was headache, reported by 11 patients (25%), followed by increased head circumference in 10 patients (22.7%). The primary etiology of hydrocephalus was intracranial tumors (34%). In five patients (11.3%), ETV was performed to address shunt malfunction following a prior VP shunt procedure. Regression of hydrocephalus occurred in 30 patients (68.1%), while 14 patients (31.8%) necessitated a subsequent VP shunt placement. Postoperative wound complications were documented in five patients (11.3%). Conclusion: ETV offers distinct advantages over traditional shunt surgery, including reduced complication risks and enhanced quality of life. Despite the influence of various factors on the success of ETV in pediatric cases, the procedure has demonstrated safety and efficacy in a significant number of patients in this demographic.

Keywords

• Hydrocephalus
• endoscopic third ventriculostomy
• ventriculoperitoneal shunt

References

1. Rekate HL. A contemporary definition and classification of hydrocephalus. Semin Pediatr Neurol 2009;16(1):9-15. [CrossRef] google scholar
2. Hochstetler A, Raskin J, Blazer-Yost BL. Hydrocephalus: historical analysis and considerations for treatment. Eur J Med Res 2022;27(1):168. [CrossRef] google scholar
3. Venkataramana NK, Mukundan CR. Evaluation of functional outcomes in congenital hydrocephalus. J Pediatr Neurosci 2011;6(1):4-12. [CrossRef] google scholar
4. Vinchon M, Baroncini M, Delestret I. Adult outcome of pediatric hydrocephalus. Childs Nerv Syst 2012;28(6):847-54. [CrossRef] google scholar
5. Farag AA, Asiri FA, Khoudir MA, Ismaeel M, Hamouda W, Alaghory IM, et. al. Endoscopic third ventriculostomy complications: avoidance and management in a stepwise manner. Egypt J Neurosurg 2022;37(1):31. [CrossRef] google scholar
6. Choudhary A, Sobti S, Zambre S, Bhaskar S. Endoscopic third ventriculostomy in failed ventriculoperitoneal shunt in pediatric population. Asian J Neurosurg 2020;15(4):937-40. [CrossRef] google scholar
7. Deininger S, Küppers J, Lehnick D, Esslinger P, Winiker H, Lehner M. Endoscopic third ventriculostomy: a feasible treatment option for pediatric hydrocephalus in a high-risk cohort - a single-center report. World J Pediatr Surg 2022;5(3):374. [CrossRef] google scholar
8. Unal TC, Gulsever CI, Sahin D, Dagdeviren HE, Dolas I, Sabanci PA, et. al. Versatile use of intraoperative ultrasound guidance for brain puncture. Oper Neurosurg 2021;21(6):409-17. [CrossRef] google scholar

9. Gürer B. Hydrocephalus - Water on the Brain. InTech. 2018. DOI: 10.5772/intechopen.69908 [CrossRef] google scholar
10. Rahman MM, Khan SIMKN, Khan RA, Islam R, Sarker MH. Endoscopic third ventriculostomy in children: problems and surgical outcome: analysis of 34 cases. Chin Neurosurg J 2021;7(1):3. [CrossRef] google scholar
11. Gangemi M, Mascari C, Maiuri F, Godano U, Donati P, Longatti PL. Long-term outcome of endoscopic third ventriculostomy in obstructive hydrocephalus. Minim Invasive Neurosurg 2007;50(5):265-9. [CrossRef] google scholar
12. Shaikh S, Deopujari CE, Karmarkar V, Muley K, Mohanty C. Role of secondary endoscopic third ventriculostomy in children: review of an ınstitutional experience. Pediatr Neurosurg 2019;54(3):188-95. [CrossRef] google scholar
13. Lee SH, Kong DS, Seol HJ, Shin HJ. Endoscopic third ventriculostomy in patients with shunt malfunction. J Korean Neurosurg Soc 2011;49(4):217-21. [CrossRef] google scholar
14. Stachura K, Grzywna E, Kwinta BM, Moskala MM. Endoscopic third ventriculostomy - effectiveness of the procedure for obstructive hydrocephalus with different etiology in adults. Wideochir Inne Tech Maloinwazyjne 2014;9(4):586-95. [CrossRef] google scholar
15. Demerdash A, Rocque BG, Johnston J, Rozzelle CJ, Yalcin B, Oskouian R, et al. Endoscopic third ventriculostomy: A historical review. Br J Neurosurg 2017;31(1):28-32. [CrossRef] google scholar
16. Deopujari CE, Karmarkar VS, Shaikh ST. Endoscopic third ventriculostomy: success and failure. J Korean Neurosurg Soc 2017;60(3):306-314. [CrossRef] google scholar
17. Jiang L, Gao G, Zhou Y. Endoscopic third ventriculostomy and ventriculoperitoneal shunt for patients with noncommunicating hydrocephalus: A PRISMA-compliant meta-analysis. Medicine (Baltimore) 2018;97(42):e12139. [CrossRef] google scholar
18. Jones RF, Stening WA, Brydon M. Endoscopic third ventriculostomy. Neurosurgery 1990;26(1):86-92. [CrossRef] google scholar
19. Lu L, Chen H, Weng S, Xu Y. Endoscopic third ventriculostomy versus ventriculoperitoneal shunt in patients with obstructive hydrocephalus: Meta-analysis of randomized controlled trials. World Neurosurg 2019;129:334-40. [CrossRef] google scholar
20. Heshmati B, Habibi Z, Golpayegani M, Salari F, Anbarlouei M, Nejat F. Endoscopic third ventriculostomy in children with failed ventriculoperitoneal shunt. Asian J Neurosurg 2019;14(2):399-402. [CrossRef] google scholar
21. Waqar M, Ellenbogen JR, Mallucci C. Endoscopic third ventriculostomy for shunt malfunction in children: A review. J Clin Neurosci 2018;51:6-11. [CrossRef] google scholar
22. Locatelli M, Draghi R, DI Cristofori A, Carrabba G, Zavanone M, Pluderi M, et al. Third ventriculostomy in late-onset ıdiopathic aqueductal stenosis treatment: A focus on clinical presentation and radiological diagnosis. Neurol Med Chir 2014;54(12):1014-21. [CrossRef] google scholar
23. Kulkarni AV, Drake JM, Mallucci CL, Sgouros S, Roth J, Constantini S. Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus. J Pediatr 2009;155(2):254-9.e1. [CrossRef] google scholar
24. Cinalli G, Özek M, Sainte-Rose C, editors. Complications of endoscopic third ventriculostomy. Pediatric Hydrocephalus. Springer, Cham; 2019. [CrossRef] google scholar
25. Hopf NJ, Grunert P, Fries G, Resch KD, Perneczky A. Endoscopic third ventriculostomy: outcome analysis of 100 consecutive procedures. Neurosurgery 1999;44(4):795-806. [CrossRef] google scholar
26. Schroeder HW, Niendorf WR, Gaab MR. Complications of endoscopic third ventriculostomy. J Neurosurg 2002;96(6):1032-40. [CrossRef] google scholar
27. Kulkarni AV, Riva-Cambrin J, Holubkov R, Browd SR, Cochrane DD, Drake JM, et al. Endoscopic third ventriculostomy in children: prospective, multicenter results from the Hydrocephalus Clinical Research Network. J Neurosurg Pediatr 2016;18(4):423-9. [CrossRef] google scholar
28. Jung TY, Chong S, Kim IY, Lee JY, Phi JH, Kim SK, et al. Prevention of complications in endoscopic third ventriculostomy. J Korean Neurosurg Soc 2017;60(3):282-8. [CrossRef] google scholar
29. Bouras T, Sgouros S. Complications of endoscopic third ventriculostomy. J Neurosurg Pediatr 2011;7(6):643-9. [CrossRef] google scholar
30. Brockmeyer D, Abtin K, Carey L, Walker ML. Endoscopic third ventriculostomy: an outcome analysis. Pediatr Neurosurg 1998;28(5):236-40. [CrossRef] google scholar