Outcome Comparison of Endoscopic Third Ventriculostomy versus Ventriculoperitoneal Shunt in Obstructive Hydrocephalus
DOI:
https://doi.org/10.36552/pjns.v25i3.583Keywords:
Cerebrospinal Fluid, Endoscopic Third Ventriculostomy, Ventriculoperitoneal ShuntAbstract
Background and Objectives: To assess the outcome of Endoscopic Third Ventriculostomy (ETV) versus Ventriculoperitoneal Shunt (VPS) in Obstructive Hydrocephalus in terms of infections, foreign bodies, cost-effectiveness, and length of hospital stay.
Materials and Methods: It was a Randomized Controlled Trial study, in which 30 patients with Obstructive Hydrocephalus were divided into two groups one was treated with (ETV) and the other was treated with VP Shunt and the patients were followed up for 1 year.
Results: Patients were divided into 2 groups, 15 were treated with ETV, and 15 were treated with VP Shunt. Length of stay for VP shunt was 7 ± 0.85 days and for ETV mean stay was 2.93 ± 1.1 days. The complication was observed in 4 (26.7%) treated with VP Shunt and in 3 (20%) patients with Endoscopic Third Ventriculostomy. In ETV, 3 (20%) patients had recurrence whereas in VP shunt in 1 (6.67%) had an infection and in 3 (20%) patients had recurrence (upper-end blockage) and the overall success rate was 76% in both the procedures and in VP Shunt 73.3% and ETV 80%. Overall there were no complications found in 23 (76.6%) patients, in 3 (10%) patient’s complications were found at 1st month, in 3 (10%) complications were observed at 3rd month, and in 1(3.3%) complication was recorded at 6th month.
Conclusion: ETV was found better in terms of length of hospital stay, cost-effectiveness as well as minimal complication rate as compared to VP shunt.
References
2. Kamalo P. Exit ventriculoperitoneal shunt; enter endoscopic third ventriculostomy (ETV): contemporary views on hydrocephalus and their implications on management. Malawi medical journal: the journal of Medical Association of Malawi. 2013; 25 (3): 78-82.
3. Hakim S, Venegas JG, Burton JD. The physics of the cranial cavity, hydrocephalus and normal pressure hydrocephalus: mechanical interpretation and mathematical model. Surg Neurol. 1976; 5 (3): 187-210.
4. Kinsman SL, Johnston MV. Congenital anomalies of the central nervous system. Nelson Textbook of Pediatrics 18th ed Philadelphia, Pa: Saunders Elsevier, 2007: 592.
5. Chance A, Sandberg DI. Hydrocephalus in patients with closed neural tube defects. Child's Nervous System, 2014; 31 (2): 329-32.
6. Cardoso ER, Galbraith S. Posttraumatic hydrocephalus—A retrospective review. Surg Neurol. 1985; 23 (3): 261-4.
7. Alkhafaji A, Hassan SF. A comparative study between ventriculoperitoneal shunt and endoscopic third ventriculostomy in the management of obstructive hydrocephalus. Iraqi Postgrad Med J. 2014; 13 (4): 486-92.
8. Zandian A, Haffner M, Johnson J, Rozzelle CJ, Tubbs RS, Loukas M. Endoscopic third ventriculostomy with/without choroid plexus cauterization for hydrocephalus due to hemorrhage, infection, Dandy-Walker malformation, and neural tube defect: a meta-analysis. Child's nervous system: ChNS: official journal of the International Society for Pediatric Neurosurgery, 2014; 30 (4): 571-8.
9. Javadpour M, Mallucci C, Brodbelt A, Golash A, May P. The Impact of Endoscopic Third Ventriculostomy on the Management of Newly Diagnosed Hydrocephalus in Infants. Pediatric Neurosurgery, 2001; 35 (3): 131-5.
10. Schroeder HW, Niendorf W-R, Gaab MR. Complications of endoscopic third ventriculostomy. Journal of Neurosurgery, 2002; 96 (6): 1032-40.
11. Eguchi S, Aihara Y, Tsuzuki S, Omura Y, Kawamata T, Okada Y. A modified method to enhance the safety of endoscopic third ventriculostomy (ETV)—transendoscopic pulse-waved microvascular Doppler-assisted ETV, technical note. Child's Nervous System, 2014; 30 (3): 515-9.
12. Bouras T, Sgouros S. Complications of endoscopic third ventriculostomy. Journal of Neurosurgery: Pediatrics, 2011; 7 (6): 643-9.
13. Rehman A-u, Rehman T-u, Bashir HH, Gupta V. A simple method to reduce infection of ventriculoperitoneal shunts. Journal of Neurosurgery: Pediatrics, 2010; 5 (6): 569-72.
14. Chow S-C, Chang M, Pong A. Statistical Consideration of Adaptive Methods in Clinical Development. Journal of Biopharmaceutical Statistics, 2005; 15: 575-91.
15. Conen A, Walti LN, Merlo A, Fluckiger U, Battegay M, Trampuz A. Characteristics and Treatment Outcome of Cerebrospinal Fluid Shunt-Associated Infections in Adults: A Retrospective Analysis over an 11-Year Period. Clinical Infectious Diseases, 2008; 47 (1): 73-82.
16. Parker SL, McGirt MJ, Murphy JA, Megerian JT, Stout M, Engelhart L. Cost Savings Associated with Antibiotic-Impregnated Shunt Catheters in the Treatment of Adult and Pediatric Hydrocephalus. World Neurosurgery, 2015; 83 (3): 382-6.
17. Azab WA, Mijalcic RM, Nakhi SB, Mohammad MH. Ventricular volume and neurocognitive outcome after endoscopic third ventriculostomy: is shunting a better option? A review. Child's Nervous System, 2016; 32 (5): 775-80.
18. Grunert P, Charalampaki P, Hopf N, Filippi R. The role of third ventriculostomy in the management of obstructive hydrocephalus. Minim Invasive Neurosurg. 2003; 46 (1): 16-21.
19. Isaacs A, Urbaneja G, Hamilton M. Endoscopic third ventriculostomy (ETV) for treatment of adult hydrocephalus: long-term followup with 163 patients. Fluids and Barriers of the CNS. 2015; 12 (1): 1-.
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