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endoscopic_third_ventriculostomy

Endoscopic third ventriculostomy (ETV)

Indications

Endoscopic third ventriculostomy Indications.

Success rate

see Endoscopic third ventriculostomy success rate.

Technique

Endoscopic Third Ventriculostomy Technique.

Videos

Failures

ETV success or failure may be influenced by numerous factors.

Absence or weakness of pulsation of the third ventricle floor at etV completion was significantly related to etV failure (p < 0.0001). The presence of thickened or scarred membranes in the subarachnoid space was significantly related to etV failure (p < 0.04) as well as the Liliequist membrane opening in a second endoscopic maneuver (p < 0.008) 1).

In infants with hydrocephalus, a greater 1-year CSF diversion failure rate may occur after ETV compared with shunt placement. This risk is most significant for procedures performed within the first 90 days of life. Further investigation of the need for multiple reoperations, cost, and impact of surgeon and hospital experience is necessary to distinguish which treatment is more effective in the long term 2).

Stoma closure

Closure of the stoma can be associated with symptom recurrence and need for further surgical intervention.

Adult patients with obstructive hydrocephalus secondary to aqueductal stenosis exhibited a low rate of stoma closure with the use of a side-cutting aspiration device, and a rate of complications comparable to the known literature. Likewise, patients treated with a side-cutting aspirator may have lower symptom recurrence post-ETV and require fewer revisions in comparison with the known literature. As such, a side-cutting aspirator may be considered as a useful adjunct to traditional ETV for the treatment of obstructive hydrocephalus secondary to aqueductal stenosis 3).

Adult patients with obstructive hydrocephalus secondary to aqueductal stenosis exhibited a low rate of stoma closure with the use of a side-cutting aspiration device, and a rate of complications comparable to the known literature. Likewise, patients treated with a side-cutting aspirator may have lower symptom recurrence post-ETV and require fewer revisions in comparison with the known literature. As such, a side-cutting aspirator may be considered as a useful adjunct to traditional ETV for the treatment of obstructive hydrocephalus secondary to aqueductal stenosis 4)

Complications

see Endoscopic third ventriculostomy complications.

Development and content validation of performance assessments for endoscopic third ventriculostomy

A study aims to develop and establish the content validity of multiple expert rating instruments to assess performance in endoscopic third ventriculostomy (ETV), collectively called the Neuro-Endoscopic Ventriculostomy Assessment Tool (NEVAT).

The important aspects of ETV were identified through a review of current literature, ETV videos, and discussion with neurosurgeons, fellows, and residents. Three assessment measures were subsequently developed: a procedure-specific checklist (CL), a CL of surgical errors, and a global rating scale (GRS). Neurosurgeons from various countries, all identified as experts in ETV, were then invited to participate in a modified Delphi survey to establish the content validity of these instruments. In each Delphi round, experts rated their agreement including each procedural step, error, and GRS item in the respective instruments on a 5-point Likert scale.

Seventeen experts agreed to participate in the study and completed all Delphi rounds. After item generation, a total of 27 procedural CL items, 26 error CL items, and 9 GRS items were posed to Delphi panelists for rating. An additional 17 procedural CL items, 12 error CL items, and 1 GRS item were added by panelists. After three rounds, strong consensus (>80% agreement) was achieved on 35 procedural CL items, 29 error CL items, and 10 GRS items. Moderate consensus (50-80% agreement) was achieved on an additional 7 procedural CL items and 1 error CL item. The final procedural and error checklist contained 42 and 30 items, respectively (divided into setup, exposure, navigation, ventriculostomy, and closure). The final GRS contained 10 items.

We have established the content validity of three ETV assessment measures by iterative consensus of an international expert panel. Each measure provides unique assessment information and thus can be used individually or in combination, depending on the characteristics of the learner and the purpose of the assessment. These instruments must now be evaluated in both the simulated and operative settings, to determine their construct validity and reliability. Ultimately, the measures contained in the NEVAT may prove suitable for formative assessment during ETV training and potentially as summative assessment measures during certification 5).

Case series

Endoscopic third ventriculostomy case series.

1)
Romero L, Ros B, Ibáñez G, Ríus F, González L, Arráez M. Endoscopic third ventriculostomy: can we predict success during surgery? Neurosurg Rev. 2014 Jan;37(1):89-97. doi: 10.1007/s10143-013-0494-6. Epub 2013 Aug 30. PubMed PMID: 23989495.
2)
Jernigan SC, Berry JG, Graham DA, Goumnerova L. The comparative effectiveness of ventricular shunt placement versus endoscopic third ventriculostomy for initial treatment of hydrocephalus in infants. J Neurosurg Pediatr. 2014 Jan 3. [Epub ahead of print] PubMed PMID: 24404970.
3) , 4)
Goodwin CR, Sankey EW, Jusué-Torres I, Elder BD, Kosztowski TA, Liu A, Hoffberger J, Lu J, Blitz AM, Rigamonti D. The Use of an Aspirating/Resecting Device to Reduce Stoma Closure Following Endoscopic Third Ventriculostomy for Aqueductal Stenosis. Neurosurgery. 2015 Jul 29. [Epub ahead of print] PubMed PMID: 26225857.
5)
Breimer GE, Haji FA, Hoving EW, Drake JM. Development and content validation of performance assessments for endoscopic third ventriculostomy. Childs Nerv Syst. 2015 Aug;31(8):1247-59. doi: 10.1007/s00381-015-2716-4. Review. PubMed PMID: 25930722.
endoscopic_third_ventriculostomy.txt · Last modified: 2020/05/05 14:08 by administrador