title: Endoscopic third ventriculostomy in patients with cerebrospinal fluid infection and/or hemorrhage.
abstract: OBJECTIVE
  In this study the authors evaluate the safety, efficacy, and indications for endoscopic third ventriculostomy (ETV) in patients with a history of subarachnoid hemorrhage or intraventricular hemorrhage (IVH) and/or cerebrospinal fluid (CSF) infection.
  
  
  METHODS
  The charts of 101 patients from seven international medical centers were retrospectively reviewed; 46 patients had a history of hemorrhage, 42 had a history of CSF infection, and 13 had a history of both disorders. All patients experienced third ventricular hydrocephalus before endoscopy. The success rate for treatment in these three groups was 60.9, 64.3, and 23.1%, respectively. The follow-up period in successfully treated patients ranged from 0.6 to 10 years. Relatively minor complications were observed in 15 patients (14.9%), and there were no deaths. A higher rate of treatment failure was associated with three factors: classification in the combined infection/hemorrhage group, premature birth in the posthemorrhage group, and younger age in the postinfection group. A higher success rate was associated with a history of ventriculoperitoneal (VP) shunt placement before ETV in the posthemorrhage group, even among those who had been born prematurely, who were otherwise more prone to treatment failure. The 13 premature infants who had suffered an IVH and who had undergone VP shunt placement before ETV had a 100% success rate. The procedure was also successful in nine of 10 patients with primary aqueductal stenosis.
  
  
  CONCLUSIONS
  Patients with obstructive hydrocephalus and a history of either hemorrhage or infection may be good candidates for ETV, with safety and success rates comparable with those in more general series of patients. Patients who have sustained both hemorrhage and infection are poor candidates for ETV, except in selected cases and as a treatment of last resort. In patients who have previously undergone shunt placement posthemorrhage, ETV is highly successful. It is also highly successful in patients with primary aqueductal stenosis, even in those with a history of hemorrhage or CSF infection.
authors.affiliation: Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv-Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel.
authors.forename: Vitaly
authors.initials: V
authors.lastname: Siomin
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cinalli
authors.forename: Andre
authors.initials: A
authors.lastname: Grotenhuis
authors.forename: Aprajay
authors.initials: A
authors.lastname: Golash
authors.forename: Shizuo
authors.initials: S
authors.lastname: Oi
authors.forename: Karl
authors.initials: K
authors.lastname: Kothbauer
authors.forename: Howard
authors.initials: H
authors.lastname: Weiner
authors.forename: Jonathan
authors.initials: J
authors.lastname: Roth
authors.forename: Liana
authors.initials: L
authors.lastname: Beni-Adani
authors.forename: Alain
authors.initials: A
authors.lastname: Pierre-Kahn
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Connor
authors.initials: C
authors.lastname: Mallucci
authors.forename: Rick
authors.initials: R
authors.lastname: Abbott
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Wisoff
authors.forename: Shlomi
authors.initials: S
authors.lastname: Constantini
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002543:Cerebral Hemorrhage / Q000150:complications / Q000601:surgery*; D002555:Cerebrospinal Fluid; D002648:Child; D002675:Child, Preschool; D004660:Encephalitis / Q000150:complications / Q000601:surgery; D004724:Endoscopy; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D020542:Third Ventricle / Q000601:surgery*; D016896:Treatment Outcome; D014696:Ventriculostomy / Q000379:methods*