Role of Endoscopic Third Ventriculostomy in the Management of Myelomeningocele-Related Hydrocephalus: A Retrospective Study in a Single French Institution.
BACKGROUND
Treatment of hydrocephalus related to myelomeningocele (MM) is debated. Endoscopic third ventriculostomy (ETV) has been proposed with contrasting results. We report our experience in the management of hydrocephalus related to MM and the advantages of ETV.


METHODS
From 1994 to 2012, we treated 97 patients with MM. Seventy patients developed a hydrocephalus needing a surgical treatment. Three types of procedures were used: ETV with concomitant choroid plexus coagulation (CPC), ETV with concomitant ventriculoperitoneal shunt (VPS), or VPS.


RESULTS
Thirty-two patients had an ETV with CPC, 20 patients had an ETV and a concomitant VPS, and 18 patients had a VPS. No perioperative complications were reported. Fifty-two patients underwent an ETV. The overall success rate of ETV was approximately 70%.


CONCLUSIONS
VPS in patients with MM leads to complications. Two common arguments are reported against ETV. The first is the variability of the anatomy of the ventricle leading to possible operative complications. The second is the immaturity of the Pacchioni granulations. For us, the modified anatomy does not prevent performing ETV. Regarding the issue of cerebrospinal fluid absorption in failed ETV, the adjunction of a shunt helps to control hydrocephalus until the maturation of the Pacchioni system.


CONCLUSIONS
Preoperative imaging helps the surgical decision to predict in which patients the ETV can be realized without risks. ETV in patients with MM is a secure procedure with low rates of failure and no mortality, and it reduces the rate of shunt implantation.
Department of Pediatric Neurosurgery, Neurological and Neurosurgical Hospital Pierre Wertheimer, Lyon, France.
Pierre-Aurelien
PA
Beuriat
Department of Pediatric Neurosurgery, Neurological and Neurosurgical Hospital Pierre Wertheimer, Lyon, France.
Alexandru
A
Szathmari
Department of Pediatric Neurosurgery, Neurological and Neurosurgical Hospital Pierre Wertheimer, Lyon, France.
Blandine
B
Grassiot
Department of Neonatal Intensive Care Unit, Mother and Children Hospital, Lyon, France.
Franck
F
Plaisant
Department of Pediatric Neurosurgery, Neurological and Neurosurgical Hospital Pierre Wertheimer, Lyon, France.
Christophe
C
Rousselle
Department of Pediatric Neurosurgery, Neurological and Neurosurgical Hospital Pierre Wertheimer, Lyon, France. Electronic address: carmine.mottolese@chu-lyon.fr.
Carmine
C
Mottolese
D002831:Choroid Plexus; D004724:Endoscopy / Q000379:methods*; D005602:France; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology* / Q000601:surgery*; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008591:Meningomyelocele / Q000150:complications*; D012189:Retrospective Studies; D016019:Survival Analysis; D020542:Third Ventricle / Q000601:surgery*; D017211:Treatment Failure; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt; D014696:Ventriculostomy / Q000379:methods*
Endoscopic third ventriculostomy; Hydrocephalus; Myelomeningocele; Outcome; Ventriculoperitoneal shunt