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Initial management of hydrocephalus associated with Chiari malformation Type I-syringomyelia complex via endoscopic third ventriculostomy: an outcome analysis.
J Neurosurg. 2008 Jun; 108(6):1211-4.JN

Abstract

OBJECT

The aim of this study was to evaluate the efficacy of endoscopic third ventriculostomy (ETV) in patients with Chiari malformation Type I (CM-I) and hydrocephalus with or without syringomyelia.

METHODS

The authors identified, in a prospective endoscopy database, 16 adults and children (age range 2-68 years) with CM-I and hydrocephalus that had been managed with ETV. They reviewed the clinical features and radiographic findings for all patients. Fifteen patients underwent ETV as a primary treatment, whereas 1 patient underwent the procedure at the time of shunt failure. All patients had symptomatic hydrocephalus with either aqueductal or fourth ventricular outflow obstruction. The mean duration of follow-up was 42 months.

RESULTS

Fifteen patients (94%) remain shunt free following ETV for CM-I. Five (83%) of the 6 patients with a syrinx had improvement or resolution of the syrinx following ETV. Six patients (37.5%) underwent foramen magnum decompression for persistent CM-I -- or syrinx-related symptoms. There was no cerebrospinal fluid leakage or intracranial pressure-related problem following foramen magnum decompression.

CONCLUSIONS

Endoscopic third ventriculostomy provides a durable method of treatment for hydrocephalus associated with CM-I. It is effective as a primary treatment, and the authors advocate its use as a replacement for routine ventriculoperitoneal shunt insertion in these patients. Management of the hydrocephalus alone is often sufficient and may obviate decompression, although a significant proportion of patients will still need both procedures.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Hayhurst C
Department of Neurosurgery, The Walton Centre for Neurology and Neurosurgery, Liverpool, UK. carolinehayhurst@hotmail.com
Osman-Farah J
No affiliation info available
Das K
No affiliation info available
Mallucci C
No affiliation info available

MeSH

AdolescentAdultAgedArnold-Chiari MalformationChildChild, PreschoolCohort StudiesDecompression, SurgicalEndoscopyHumansHydrocephalusMiddle AgedRetrospective StudiesSyringomyeliaThird VentricleTreatment OutcomeVentriculostomy

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18518729

Citation

Hayhurst, Caroline, et al. "Initial Management of Hydrocephalus Associated With Chiari Malformation Type I-syringomyelia Complex Via Endoscopic Third Ventriculostomy: an Outcome Analysis." Journal of Neurosurgery, vol. 108, no. 6, 2008, pp. 1211-4.
Hayhurst C, Osman-Farah J, Das K, et al. Initial management of hydrocephalus associated with Chiari malformation Type I-syringomyelia complex via endoscopic third ventriculostomy: an outcome analysis. J Neurosurg. 2008;108(6):1211-4.
Hayhurst, C., Osman-Farah, J., Das, K., & Mallucci, C. (2008). Initial management of hydrocephalus associated with Chiari malformation Type I-syringomyelia complex via endoscopic third ventriculostomy: an outcome analysis. Journal of Neurosurgery, 108(6), 1211-4. https://doi.org/10.3171/JNS/2008/108/6/1211
Hayhurst C, et al. Initial Management of Hydrocephalus Associated With Chiari Malformation Type I-syringomyelia Complex Via Endoscopic Third Ventriculostomy: an Outcome Analysis. J Neurosurg. 2008;108(6):1211-4. PubMed PMID: 18518729.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Initial management of hydrocephalus associated with Chiari malformation Type I-syringomyelia complex via endoscopic third ventriculostomy: an outcome analysis. AU - Hayhurst,Caroline, AU - Osman-Farah,Jibril, AU - Das,Kumar, AU - Mallucci,Conor, PY - 2008/6/4/pubmed PY - 2008/7/11/medline PY - 2008/6/4/entrez SP - 1211 EP - 4 JF - Journal of neurosurgery JO - J Neurosurg VL - 108 IS - 6 N2 - OBJECT: The aim of this study was to evaluate the efficacy of endoscopic third ventriculostomy (ETV) in patients with Chiari malformation Type I (CM-I) and hydrocephalus with or without syringomyelia. METHODS: The authors identified, in a prospective endoscopy database, 16 adults and children (age range 2-68 years) with CM-I and hydrocephalus that had been managed with ETV. They reviewed the clinical features and radiographic findings for all patients. Fifteen patients underwent ETV as a primary treatment, whereas 1 patient underwent the procedure at the time of shunt failure. All patients had symptomatic hydrocephalus with either aqueductal or fourth ventricular outflow obstruction. The mean duration of follow-up was 42 months. RESULTS: Fifteen patients (94%) remain shunt free following ETV for CM-I. Five (83%) of the 6 patients with a syrinx had improvement or resolution of the syrinx following ETV. Six patients (37.5%) underwent foramen magnum decompression for persistent CM-I -- or syrinx-related symptoms. There was no cerebrospinal fluid leakage or intracranial pressure-related problem following foramen magnum decompression. CONCLUSIONS: Endoscopic third ventriculostomy provides a durable method of treatment for hydrocephalus associated with CM-I. It is effective as a primary treatment, and the authors advocate its use as a replacement for routine ventriculoperitoneal shunt insertion in these patients. Management of the hydrocephalus alone is often sufficient and may obviate decompression, although a significant proportion of patients will still need both procedures. SN - 0022-3085 UR - https://www.unboundmedicine.com/medline/citation/18518729/Initial_management_of_hydrocephalus_associated_with_Chiari_malformation_Type_I_syringomyelia_complex_via_endoscopic_third_ventriculostomy:_an_outcome_analysis_ DB - PRIME DP - Unbound Medicine ER -