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Complications of Endoscopic Third Ventriculostomy: A Systematic Review

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Hydrocephalus

Part of the book series: Acta Neurochirurgica Supplementum ((NEUROCHIRURGICA,volume 113))

Abstract

Introduction: Endoscopic third ventriculostomy (ETV) is an established treatment for hydrocephalus. Most studies focus on success rates, and complications are insufficiently charted. The aim of this study was to perform a systematic review of ETV complications.

Methods: A Medline search discovered 24 series of ETV (seven in children, five in adults, and 12 in a mixed-age group) with detailed complications reports.

Results: The analysis included 2,672 ETVs performed on 2,617 patients. The cause of hydrocephalus was aqueductal stenosis in 25.9%, tumor 37.0%, meningomyelocele–Chiari II 6.1%, posthemorrhagic 5.8%, postinfectious 1.4%, cysts 3.3%, Chiari I 0.4%, Dandy-Walker malformation 0.3%, cerebellar infarct 0.9%, normal pressure hydrocephalus 1.3%, and not recorded 16.8%. Overall complication rate was 8.8%. Permanent morbidity was 2.1%, neurologic in 1.2% (hemiparesis, gaze palsy, memory disorders, and/or altered consciousness), hypothalamic in 0.9% (diabetes insipidus, weight gain, or precocious puberty). Intraoperative hemorrhage was present in 3.9%, severe in 0.6% (including four cases [0.14%] of basilar rupture). Other surgical complications were 1.13% (three thalamic infarcts, six subdural, six intracerebral, and two epidural hematomas). Cerebrospinal fluid (CSF) infections occurred in 1.8%, CSF leak in 1.7%, anesthetic complications (bradycardia and hypotension) in 0.19% of cases. Postoperative mortality was 0.22% (six patients; sepsis two, hemorrhage three, and thalamic injury one). Another two children suffered delayed “sudden death” (after 25 and 60 months), caused by acute hydrocephalus due to stoma occlusion. There were no differences between pediatric and adult patients or short and long series (cutoff 100 patients). All deaths were reported in long series. Complication rates were insignificantly higher in short series.

Conclusions: Permanent morbidity after ETV is 2.1%, mortality is 0.22%. The incidence of delayed “sudden death” is 0.07%.

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We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Department of Neurosurgery, “Attikon” University Hospital, Athens, Greece

    Triantafyllos Bouras & Spyros Sgouros

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  1. Triantafyllos Bouras
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  2. Spyros Sgouros
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Correspondence to Spyros Sgouros .

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Editors and Affiliations

  1. , Department of Neurosurgery, VCU Medical Center, East Marshall Street 1250, Richmond, 23294, Virginia, USA

    Gunes A. Aygok

  2. Chiari Institute, Northern Blvd., Great Neck, 11012, USA

    Harold L. Rekate

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Bouras, T., Sgouros, S. (2012). Complications of Endoscopic Third Ventriculostomy: A Systematic Review. In: Aygok, G., Rekate, H. (eds) Hydrocephalus. Acta Neurochirurgica Supplementum, vol 113. Springer, Vienna. https://doi.org/10.1007/978-3-7091-0923-6_30

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  • DOI: https://doi.org/10.1007/978-3-7091-0923-6_30

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  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-7091-0922-9

  • Online ISBN: 978-3-7091-0923-6

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