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Endoscopic third ventriculostomy for the management of Chiari I and related hydrocephalus: outcome and pathogenetic implications.
Neurosurgery. 2011 Apr; 68(4):950-6.N

Abstract

BACKGROUND

Hydrocephalus affects 7% to 10% of patients with Chiari I malformation (CIM). It can be successfully treated by endoscopic third ventriculostomy (ETV), possibly improving related CIM and syringomyelia.

OBJECTIVE

To confirm the effectiveness of ETV in the management of Chiari-related hydrocephalus and symptoms and to estimate the posterior cranial fossa volume (PCFV) to find the possible reasons for the success or failure of ETV.

METHODS

Fifteen patients (11 children and 4 adults) underwent ETV for hydrocephalus associated with CIM (syringomyelia was present in 6 patients). Preoperative PCFV, posterior fossa brain volume (PFBV), and PFBV/PCFV ratio were calculated in the last 12 patients in the series by a magnetic resonance imaging-based computerized method.

RESULTS

All patients had symptomatic hydrocephalus (mean third ventricle diameter, 14.1 mm). Mean tonsillar ectopia was 12.7 mm. Postoperatively, hydrocephalus symptoms improved in all cases (mean third ventricle diameter, 8.3 mm); signs and symptoms of CIM and syringomyelia resolved or improved in all patients, although the malformation remained radiologically stable in half of the patients (postoperative mean tonsillar ectopia, 8.8 mm). There were no remarkable differences between cases and controls with regard to PCFV and PFBV. The PFBV/PCFV ratio was comparable in pediatric cases and controls but not among adult patients, suggesting a PCF overcrowding in the controls.

CONCLUSION

ETV is an effective treatment for hydrocephalus associated with CIM. It is successful in improving CIM and syringomyelia in patients with no overcrowding (mainly in children) or with reversible overcrowding of the PCF (mainly in adults).

Authors+Show Affiliations

Institute of Neurosurgery, A. Gemelli Hospital, Rome, Italy. lmassimi@email.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

21221038

Citation

Massimi, Luca, et al. "Endoscopic Third Ventriculostomy for the Management of Chiari I and Related Hydrocephalus: Outcome and Pathogenetic Implications." Neurosurgery, vol. 68, no. 4, 2011, pp. 950-6.
Massimi L, Pravatà E, Tamburrini G, et al. Endoscopic third ventriculostomy for the management of Chiari I and related hydrocephalus: outcome and pathogenetic implications. Neurosurgery. 2011;68(4):950-6.
Massimi, L., Pravatà, E., Tamburrini, G., Gaudino, S., Pettorini, B., Novegno, F., Colosimo, C., & Di Rocco, C. (2011). Endoscopic third ventriculostomy for the management of Chiari I and related hydrocephalus: outcome and pathogenetic implications. Neurosurgery, 68(4), 950-6. https://doi.org/10.1227/NEU.0b013e318208f1f3
Massimi L, et al. Endoscopic Third Ventriculostomy for the Management of Chiari I and Related Hydrocephalus: Outcome and Pathogenetic Implications. Neurosurgery. 2011;68(4):950-6. PubMed PMID: 21221038.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endoscopic third ventriculostomy for the management of Chiari I and related hydrocephalus: outcome and pathogenetic implications. AU - Massimi,Luca, AU - Pravatà,Emanuele, AU - Tamburrini,Gianpiero, AU - Gaudino,Simona, AU - Pettorini,Benedetta, AU - Novegno,Federica, AU - Colosimo,Cesare,Jr AU - Di Rocco,Concezio, PY - 2011/1/12/entrez PY - 2011/1/12/pubmed PY - 2012/5/9/medline SP - 950 EP - 6 JF - Neurosurgery JO - Neurosurgery VL - 68 IS - 4 N2 - BACKGROUND: Hydrocephalus affects 7% to 10% of patients with Chiari I malformation (CIM). It can be successfully treated by endoscopic third ventriculostomy (ETV), possibly improving related CIM and syringomyelia. OBJECTIVE: To confirm the effectiveness of ETV in the management of Chiari-related hydrocephalus and symptoms and to estimate the posterior cranial fossa volume (PCFV) to find the possible reasons for the success or failure of ETV. METHODS: Fifteen patients (11 children and 4 adults) underwent ETV for hydrocephalus associated with CIM (syringomyelia was present in 6 patients). Preoperative PCFV, posterior fossa brain volume (PFBV), and PFBV/PCFV ratio were calculated in the last 12 patients in the series by a magnetic resonance imaging-based computerized method. RESULTS: All patients had symptomatic hydrocephalus (mean third ventricle diameter, 14.1 mm). Mean tonsillar ectopia was 12.7 mm. Postoperatively, hydrocephalus symptoms improved in all cases (mean third ventricle diameter, 8.3 mm); signs and symptoms of CIM and syringomyelia resolved or improved in all patients, although the malformation remained radiologically stable in half of the patients (postoperative mean tonsillar ectopia, 8.8 mm). There were no remarkable differences between cases and controls with regard to PCFV and PFBV. The PFBV/PCFV ratio was comparable in pediatric cases and controls but not among adult patients, suggesting a PCF overcrowding in the controls. CONCLUSION: ETV is an effective treatment for hydrocephalus associated with CIM. It is successful in improving CIM and syringomyelia in patients with no overcrowding (mainly in children) or with reversible overcrowding of the PCF (mainly in adults). SN - 1524-4040 UR - https://www.unboundmedicine.com/medline/citation/21221038/Endoscopic_third_ventriculostomy_for_the_management_of_Chiari_I_and_related_hydrocephalus:_outcome_and_pathogenetic_implications_ L2 - https://academic.oup.com/neurosurgery/article-lookup/doi/10.1227/NEU.0b013e318208f1f3 DB - PRIME DP - Unbound Medicine ER -