title: Simultaneous ventriculoperitoneal shunt removal and endoscopic third ventriculostomy for three patients previously treated for intracranial germ cell tumors more than 20 years ago.
abstract: BACKGROUND
  Obstructive hydrocephalus is the most common complication of intracranial germ cell tumors (IGCTs). Although ventriculoperitoneal shunts (VPSs) were previously used for treating this condition, they have recently been replaced by endoscopic third ventriculostomy (ETV), as the latter can avoid various complications caused by a VPS and can preserve physiological cerebrospinal fluid (CSF) dynamics. Therefore, if a VPS malfunctioned in patients who had previously been treated for IGCTs, it seems reasonable to consider removing the problematic VPS, followed by ETV, as long as magnetic resonance imaging reveals third ventricle floor ballooning and the cause of obstruction in the ventricular system, which are indicators for ETV.
  
  
  METHODS
  Here, we present the cases of three patients who underwent simultaneous removal of malfunctioning VPSs and ETV, more than 20 years (range 20-27 years) after initial treatment for IGCT and relevant obstructive hydrocephalus. Despite a relatively long shunt dependency, their obstructive hydrocephalus was well-managed by ETV, probably because CSF absorptive capacity remained intact after IGCT ablation by radio-chemotherapy.
  
  
  CONCLUSIONS
  Patients with previously treated IGCTs can thus be released from the need for a VPS, regardless of long-term shunt dependency.
authors.affiliation: Department of Neurosurgery, Kanazawa University Hospital, 13-1, Takara-machi, Kanazawa, 920-8641, Japan. dk.md.phd@gmail.com.
authors.forename: Daisuke
authors.identifier: http://orcid.org/0000-0002-2149-4316
authors.initials: D
authors.lastname: Kita
authors.affiliation: Department of Neurosurgery, Kanazawa University Hospital, 13-1, Takara-machi, Kanazawa, 920-8641, Japan.
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Hayashi
authors.affiliation: Department of Neurosurgery, Kanazawa University Hospital, 13-1, Takara-machi, Kanazawa, 920-8641, Japan.
authors.forename: Issei
authors.initials: I
authors.lastname: Fukui
authors.affiliation: Department of Neurosurgery, Kanazawa University Hospital, 13-1, Takara-machi, Kanazawa, 920-8641, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Oishi
authors.affiliation: Department of Neurosurgery, Kanazawa University Hospital, 13-1, Takara-machi, Kanazawa, 920-8641, Japan.
authors.forename: Mitsutoshi
authors.initials: M
authors.lastname: Nakada
mesh_terms: D000328:Adult; D019723:Endoscopes; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009373:Neoplasms, Germ Cell and Embryonal / Q000000981:diagnostic imaging / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D020542:Third Ventricle / Q000601:surgery*; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt / Q000379:methods*
keywords: Endoscopic third ventriculostomy; Intracranial germ cell tumor; Obstructive hydrocephalus; Shunt malfunction