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- Title
Third ventricular shape: a predictor of endoscopic third ventriculostomy success.
- Authors
Wong, Andrew; Foroughi, Mansoor; Steinbok, Paul; Singhal, Ash; Sargent, Michael; Cochrane, Douglas
- Abstract
INTRODUCTION: Two main surgical treatments for hydrocephalus exist: endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunting. ETV is favorable as it is minimally invasive as well as provides for a decreased risk of infection, blockage and over-drainage. To date, however, the criteria for identifying good ETV candidates preoperatively, and assessment of success postoperatively remains in evolution. OBJECTIVES: Preoperatively, does displacement of the third ventricle floor (TVF) inferiorly and lamina terminalis (LT) anteriorly predict clinical success Postoperatively, does resolution of such displacements correlate with success METHODS: MR imaging of 39 consecutive patients treated at BC Children's Hospital between 2004 and 2010 was reviewed to assess displacement of the TVF and LT prior to and following ETV. Displacements of the TVF and LT were judged qualitatively and quantitatively, using a new index, the Third Ventricular Morphology Index (TVMI). The association between morphological features and clinical success of ETV was analyzed. RESULTS: Patients with displacement of both the TVF and LT pre-operatively underwent a successful ETV ninety-six percent of the time. The TVMI correlated with the qualitative assessments of displacement. Postoperative decrease in the TVMI occurred in all successfully treated patients. Further, changes in TVMI preceded and were of greater magnitude than those of the current best index, the Frontal and Occipital Horn Ratio (FOHR). CONCLUSIONS: Assessment of TVF and LT morphology is useful in predicting clinical success of ETV and in the follow up of patients so treated. The TVMI provides a quantitative assessment of the 3rd ventricular morphology which may prove useful in equivocal cases for the management of hydrocephalic patients.
- Subjects
HYDROCEPHALUS; ENDOSCOPIC ultrasonography; SURGICAL anastomosis; HYDROCEPHALUS in children; BRAIN diseases
- Publication
UBC Medical Journal, 2011, Vol 2, Issue 2, p18
- ISSN
1920-7425
- Publication type
Abstract