title: Endoscopic third ventriculostomy in the treatment of shunt-related over-drainage: Preliminary experience with a new approach how to render ventricles navigable.
abstract: OBJECTIVE
  Endoscopic third ventriculostomy (ETV) is increasingly used for the treatment of shunt-related complications in hydrocephalic patients, particularly if the etiology of the underlying hydrocephalus is of obstructive nature.
  
  
  OBJECTIVE
  Due to the slit-like configuration of the ventricles, ventricular dilatation must be achieved prior to ETV in patients with problems due to over-drainage. This has been accomplished by ligating or explanting the shunt. Here we present an alternative procedure using a gravitational antisiphon device.
  
  
  METHODS
  In two patients with over-drainage due to shunted occlusive hydrocephalus ventricles were dilated by integrating an antisiphon device (Miethke ShuntAssistant, Aesculap AG, Tuttlingen, Germany) into their shunt systems. The resistance of the antisiphon device, which is available in configurations from 10 to 35 cm H2O was chosen 10 cm H2O higher than necessary to prevent siphoning in the individual patient.
  
  
  RESULTS
  Both patients gradually recovered from their over-drainage symptoms and the ventricles enlarged enough to allow access with an endoscope. Using a standard procedure, ETV was performed 7 days and 1 month later, respectively. In the same operative session the shunts were occluded. Shunts were removed within 6 weeks after ETV. During follow-up of more than 3 years, both patients remained free of symptoms.
  
  
  CONCLUSIONS
  The incorporation of an antisiphon device with resistance level selected 10 cm H2O higher than needed to prevent anti-siphoning into a pre-existing shunt system in patients suffering from shunt-related over-drainage is a safe and effective technique to render ventricles large enough to allow endoscopic access for ETV.
authors.affiliation: Department of Neurosurgery, Mannheim University Hospital, Theodor-Kutzer-ufer 1-3, D-68167 Mannheim, Germany. juergen.boschert@nch.ma.uni-heidelberg.de
authors.forename: Jürgen M
authors.initials: JM
authors.lastname: Boschert
authors.forename: Joachim K
authors.initials: JK
authors.lastname: Krauss
mesh_terms: D000328:Adult; D020878:Device Removal; D004106:Dilatation / Q000295:instrumentation*; D004868:Equipment Failure; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D044583:Neuroendoscopy; D011859:Radiography; D020542:Third Ventricle / Q000601:surgery*; D017287:Ventriculoperitoneal Shunt / Q000295:instrumentation*; D014696:Ventriculostomy