title: Effectiveness of Intraventricular Endoscopic Lamina Terminalis Fenestration in Comparison with Standard ETV: Systematic Review of Literature.
abstract: BACKGROUND
  Endoscopic third ventriculostomy is a consolidated technique for the treatment of hydrocephalus. Despite its effectiveness and feasibility, several technical limitations about its use in certain situations have been described. Lamina terminalis-endoscopic third ventriculostomy (LT-ETV) has been proposed as an alternative technique. Authors systematically reviewed the literature in order to define the effectiveness and limits in comparison with standard ETV.
  
  
  METHODS
  This systematic review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. It has also been registered with the PROSPERO International Prospective Register of Systematic Reviews (CRD42016041596). MEDLINE, Web of Knowledge, and EMBASE were independently searched.
  
  
  RESULTS
  Seven studies were found to be eligible. A case of ours was added to the series, totaling 41 patients (mean patient age ± SD was 21.6 ± 20.7 years). Endoscopic findings leading surgeons to perform LT-ETV were abnormal ventricular anatomy (24, 57%), inadequate/insufficient interpeduncular subarachnoid space (11, 26%), a combination of both (5, 12%), and intraoperatory, unsatisfactory third ventricle floor fenestration (2, 5%). Most common pathologies were neurocysticercosis (12, 28.57%), aqueductal stenosis (8, 19%), tuberculous meningitis (4, 9.52%), and medulloblastoma (3, 7.14%). A flexible endoscope was the most used device (36 procedures, 86%), while not determining a statistical relevant diminution of complications in comparison with a rigid endoscope (P = 1.0). An overall success rate of 69% was registered, increasing to 89% if just the first year of follow-up was considered.
  
  
  CONCLUSIONS
  LT-ETV can be considered a successful technical option when standard ETV cannot be performed, although more complex cerebrovascular anatomy is involved. Therefore we suggest that lateral terminalis fenestration is a valid technical option in experienced hands.
authors.affiliation: Department of Medicine and Surgery, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy. Electronic address: carlo.giussani@unimib.it.
authors.forename: Carlo
authors.initials: C
authors.lastname: Giussani
authors.affiliation: Department of Medicine and Surgery, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy.
authors.forename: Lelio
authors.initials: L
authors.lastname: Guida
authors.affiliation: Department of Medicine and Surgery, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Trezza
authors.affiliation: Department of Medicine and Surgery, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy.
authors.forename: Erik Pietro
authors.initials: EP
authors.lastname: Sganzerla
mesh_terms: D002528:Cerebellar Neoplasms / Q000150:complications; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000601:surgery*; D007031:Hypothalamus / Q000601:surgery*; D008527:Medulloblastoma / Q000150:complications; D020019:Neurocysticercosis / Q000150:complications; D044583:Neuroendoscopy / Q000379:methods*; D020542:Third Ventricle / Q000601:surgery*; D016896:Treatment Outcome; D014390:Tuberculosis, Meningeal / Q000150:complications; D014696:Ventriculostomy / Q000379:methods*
keywords: Endoscopic third ventriculostomy; Hydrocephalus; Lamina terminalis; Lamina terminalis–endoscopic third ventriculostomy; Neuroendoscopy