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Child's Nervous System
Published in: Child's Nervous System 12/2006

01-12-2006 | Focus Session

Shunts vs endoscopic third ventriculostomy in infants: are there different types and/or rates of complications?

A review

Authors: C. Di Rocco, L. Massimi, G. Tamburrini

Published in: Child's Nervous System | Issue 12/2006

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Abstract

Introduction

The decision-making process when we compare endoscopic third ventriculostomy (ETV) with shunts as surgical options for the treatment of hydrocephalus in infants is conditioned by the incidence of specific and shared complications of the two surgical procedures.

Review

Our literature review shows that the advantages of ETV in terms of complications are almost all related to two factors: (a) the avoidance of a foreign body implantation and (b) the establishment of a ‘physiological’ cerebrospinal fluid (CSF) circulation. Both these kinds of achievements are particularly important in infants because of the relative high rate of some intraoperative (i.e. abdominal) and late (secondary craniosynostosis, slit-ventricle syndrome) shunt complications in this specific subset of patients. On the other side, the main factor which is claimed against ETV is the relatively high risk of immediate mortality and neurological complications. Clinical manifestations of neurological structure damage seem to be more frequent in infants, probably due to the more relevant effect of parenchymal and vascular damage in this age group; however, both the immediate mortality and neurological damage risk of ETV procedures should be weighted against the long-term mortality and the late neurological damage which is not infrequently described as a consequence of shunt malfunction and proximal shunt revision procedures. Infections are possible in both ETV and extrathecal CSF procedures, especially in infants. However, the incidence of infective complications is significantly lower in case of ETV (1–5% vs 1–20%). Moreover, different from shunting procedures, infections in children with third ventriculostomy have a more benign course, being generally controlled by antibiotic treatment alone.
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Metadata
Title
Shunts vs endoscopic third ventriculostomy in infants: are there different types and/or rates of complications?
A review
Authors
C. Di Rocco
L. Massimi
G. Tamburrini
Publication date
01-12-2006
Publisher
Springer-Verlag
Published in
Child's Nervous System / Issue 12/2006
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI
https://doi.org/10.1007/s00381-006-0194-4

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