title: Long-term change in ventricular size following endoscopic third ventriculostomy for hydrocephalus due to tectal plate gliomas.
abstract: OBJECTIVE
  Endoscopic third ventriculostomy (ETV) is an alternative to shunt placement in children with hydrocephalus due to tectal plate gliomas (TPGs). However, controversy remains regarding the amount of ventricular size reduction that should be expected after ETV. This study investigates ventricular size change after ETV for TPGs.
  
  
  METHODS
  Twenty-two children were identified from a 15-year retrospective database of neuroendoscopic procedures performed at the authors' institution, Children's Hospital of Alabama, in patients with a minimum of 1 year of follow-up. Clinical outcomes, including the need for further CSF diversion and symptom resolution, were recorded. The frontal and occipital horn ratio (FOR) was measured on pre- and postoperative, 1-year, and last follow-up imaging studies.
  
  
  RESULTS
  In 17 (77%) of 22 children no additional procedure for CSF diversion was required. Of those in whom CSF diversion failed, 4 underwent successful repeat ETV and 1 required shunt replacement. Therefore, in 21 (96%) of 22 patients, CSF diversion was accomplished with ETV. Preoperative and postoperative imaging was available for 18 (82%) of 22 patients. The FOR decreased in 89% of children who underwent ETV. The FOR progressively decreased 1.7%, 11.2%, and 12.7% on the initial postoperative, 1-year, and last follow-up images, respectively. The mean radiological follow-up duration for 18 patients was 5.4 years. When ETV failed, the FOR increased at the time of failure in all patients. Failure occurred 1.6 years after initial ETV on average. The mean clinical follow-up period for all 22 patients was 5.3 years. In all cases clinical improvement was demonstrated at the last follow-up.
  
  
  CONCLUSIONS
  Endoscopic third ventriculostomy successfully treated hydrocephalus in the extended follow-up period of patients with TPGs. The most significant reduction in ventricular size was observed at the the 1-year followup, with only modest reduction thereafter.
authors.affiliation: Section of Pediatric Neurosurgery, Division of Neurosurgery, University of Alabama, Children's Hospital, Birmingham, AL, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Romeo
authors.forename: Robert P
authors.initials: RP
authors.lastname: Naftel
authors.forename: Christoph J
authors.initials: CJ
authors.lastname: Griessenauer
authors.forename: Gavin T
authors.initials: GT
authors.lastname: Reed
authors.forename: Richard
authors.initials: R
authors.lastname: Martin
authors.forename: Chevis N
authors.initials: CN
authors.lastname: Shannon
authors.forename: Paul A
authors.initials: PA
authors.lastname: Grabb
authors.forename: R Shane
authors.initials: RS
authors.lastname: Tubbs
authors.forename: John C
authors.initials: JC
authors.lastname: Wellons
mesh_terms: D000293:Adolescent; D000768:Anesthesia, General; D020295:Brain Stem Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D002552:Cerebral Ventricles / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D005910:Glioma / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000473:pathology* / Q000601:surgery*; D019586:Intracranial Hypertension / Q000188:drug therapy / Q000473:pathology; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D011859:Radiography; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome; D014696:Ventriculostomy