Prognostic factors for endoscopic third ventriculostomy success in hydrocephalus with myelomeningocele.

PURPOSE: Myelomeningocele (MMC) is a prevalent neural tube closure defect often associated with hydrocephalus, necessitating surgical intervention in a significant proportion of cases. While ventriculoperitoneal shunting (VPS) has been a standard treatment approach, endoscopic third ventriculostomy (ETV) has emerged as a promising alternative. However, factors influencing the success of ETV in MMC patients remain uncertain. This retrospective observational study aimed to identify clinical and radiological factors correlating with a higher success rate of ETV in MMC patients. METHODS: Medical records of MMC patients who underwent ETV at a tertiary care center between 2015 and 2021 were reviewed. Demographic, clinical, and radiological data were analyzed. ETV success was defined as the absence of further hydrocephalus treatment during follow-up. RESULTS: Of 131 MMC patients, 21 met inclusion criteria and underwent ETV. The overall success rate of ETV was 57.1%, with a six-month success rate of 61.9%. Age ≤ 6 months was significantly associated with lower ETV success (25%) compared to older patients (76.9%) (OR: 0.1; 95% CI 0.005-2.006; p = 0.019). Radiological factors, including posterior fossa dimensions and linear indices, did not exhibit statistically significant associations with ETV success. CONCLUSION: Age emerged as a significant factor affecting ETV success in MMC patients, with younger patients exhibiting lower success rates. Radiological variables did not significantly influence ETV outcomes in this study. Identifying predictors of ETV success in MMC patients is crucial for optimizing treatment strategies and improving patient outcomes.

Endoscopic third ventriculostomy in hydrocephalus secondary to vestibular schwannomas / Tercer ventriculostomía endoscópica en la hidrocefalia secundaria a schwanomas vestibulares

Introduction: Treatment options for hydrocephalus related to posterior fossa tumors have been extensively studied in the pediatric population, but the value of endoscopic third ventriculostomy in hydrocephalus secondary to vestibular schwannoma in adults, is controversial. A systematic search of the medical literature was carried out in Pubmed/Medline and SciElo for the identification and inclusion of articles, in addition to the preprint servers bioRxiv and medRxiv. The following descriptors were used: hydrocephalus and vestibular schwannomas or acoustic neuromas or acoustic neurinomas and endoscopic third ventriculostomy. The initial search found 195 articles. After selection, 5 articles were chosen for the study. Objective: To specify the role of the endoscopic third ventriculostomy in hydrocephalus secondary to vestibular schwannomas. Development: The articles included a total of 82 patients, in which an improvement of the symptoms was achieved in 86.6 percent of the cases. The decrease in ventricular diameter was reported in 82.9 percent of the cases and was only found explicit in 3 articles. Although the failure criteria used were varied, 2 of them predominated: the persistence of progressive symptomatic hydrocephalus and/or the need for shunt placement. Endoscopic third ventriculostomy failure only represented 14.6 percent. Conclusions: Third ventriculostomy is an acceptable technique with relative success for the treatment of symptomatic obstructive hydrocephalus secondary to vestibular schwannomas(AU)

Introducción: Las opciones de tratamiento para la hidrocefalia relacionada con tumores de fosa posterior han sido ampliamente estudiadas en la población pediátrica, pero es controvertido el valor de la tercer ventriculostomía endoscópica, en la hidrocefalia secundaria a schwanoma vestibular en adultos, previo a la resección del tumor. Se realizó una búsqueda sistemática de la literatura médica en Pubmed/Medline y SciElo para la identificación e inclusión de artículos, además de los servidores de preprint bioRxiv y medRxiv. Se utilizaron los siguientes descriptores: hydrocephalus y vestibular schwannomas o acoustic neuromas o acoustic neurinomas y endoscopic third ventriculostomy. La búsqueda inicial encontró 195 artículos. Después de la selección, se eligieron 5 artículos para el estudio. Objetivo: Especificar el papel de la tercer ventriculostomía endoscópica en la hidrocefalia secundaria a schwanomas vestibulares. Desarrollo: Los artículos incluyeron un total de 82 pacientes, en los que se logró una mejoría de los síntomas en el 86,6 por ciento de los casos. La disminución del diámetro ventricular se reportó en el 82,9 por ciento de los casos y solo se encontró explícita en 3 artículos. Aunque los criterios de fracaso utilizados fueron variados, predominaron dos de ellos: la persistencia de hidrocefalia sintomática progresiva o la necesidad de colocación de derivación. La falla de la tercer ventriculostomía endoscópica solo representó el 14,6 por ciento. Conclusiones: La tercera ventriculostomía endoscópica es una técnica aceptable y con relativo éxito para el tratamiento de la hidrocefalia obstructiva sintomática secundaria a schwanomas vestibulares(AU)

Percutaneous fetal endoscopic third ventriculostomy for severe isolated cerebral ventriculomegaly.

OBJECTIVE: To demonstrate the feasibility and preliminary results of percutaneous fetal endoscopic third ventriculostomy (ETV) in human fetuses (pfETV) with isolated progressive and/or severe bilateral cerebral ventriculomegaly (IPSBV). METHODS: The initial results of pfETV for IPSBV were described. Perioperative, perinatal and postnatal variables were described. The Ages and Stages Questionnaire (ASQ-3), 3rd edition (ASQ-3) was used for follow-up of all infants. RESULTS: Successful pfETV was performed in 10/11 (91%) fetuses, at a median gestational age (GA) of 28.7 weeks (25.3-30.7). There were no perioperative complications. After pfETV, 70% (7/10) of the fetuses had a decreased or stabilized lateral ventricle atria|lateral ventricle's atria. The median GA at delivery was 38.2 weeks (35.9-39.3). There were no perinatal complications. The postnatal ventriculoperitoneal shunt rate was 80% (8/10). Among neonates/infants who had prenatal stabilization or a decrease in the LVAs, 4 (4/7: 57.1%) had abnormal scores on the ASQ-3. Among neonates/infants that experienced prenatal increases in the LVAs, all of them (3/3: 100%) had abnormal scores on the ASQ-3. CONCLUSION: Percutaneous ETV is feasible in human fetuses with progressive and/or severe cerebral ventriculomegaly and seems to be a safe procedure for both the mother and the fetus.

Disparities in Postoperative Communication Patterns Among Spanish-speaking Pediatric Patients with Hydrocephalus.

OBJECTIVE: To determine if differences exist in postoperative communication patterns or healthcare use among English-speaking patients (ESPs) and Spanish-speaking patients (SSPs) with childhood hydrocephalus. STUDY DESIGN: A single-institution, retrospective cohort study was conducted. Through simple random sampling, 50 ESPs and 50 SSPs (<18 years old) who underwent a ventriculoperitoneal shunt or endoscopic third ventriculostomy were identified. Demographics, communication with clinic (eg, number of calls or messages postoperatively), and healthcare use were collected. Multiple linear regressions assessed the significance of predictors on communication frequency and use. RESULTS: SSPs were more likely to have a comorbidity and ventriculoperitoneal shunt than ESPs. SSPs had longer median postoperative length of stay (P < .01) and 30-day readmission rate (P < .01) than ESPs. Only 18% of SSPs communicated with clinic; 11 total calls or messages were from SSPs vs 57 from ESPs (P < .01). The most common reason for outreach among both cohorts was a new symptom. ESP outreach most frequently resulted in reassurance or medical course changes on an outpatient basis (30% ESPs vs 0% SSPs; P = .04), whereas SSP outreach most frequently resulted in guidance to present to the emergency department (3% ESPs vs 36% SSPs; P < .01). Language remained a significant predictor for number of calls or messages, even after adjusting for comorbidity, operation type, and insurance (P < .01). CONCLUSIONS: Despite having more complex disease, only 18% of SSPs communicated with the neurosurgical team postoperatively and were more frequently sent to the emergency department for management. Future research will explore communication barriers and preferences to ensure postoperative care is timely and patient centered.

Posterior fossa choroidplexus papilloma in the pediatric population: case series and literature review.

Choroid plexus papillomas (CPPs) are rare benign neoplasms which are particularly uncommon in the posterior fossa in children. We herein present a case series of five patients treated at a tertiary care hospital. A comprehensive literature review was also carried out. The patients treated at the tertiary care hospital were aged between 4 and 16 years. Gross total resection (GTR) was initially achieved in two patients. All patients showed clinical improvement. Moreover, 27 articles published between 1975 and 2021 were selected for the literature review, totaling 46 patients; with the 5 patients previously described, the total sample was composed of 51 cases, With a mean age was 8.2 years. The lesions were located either in the fourth ventricle (65.3%) or the cerebellopontine angle (34.7%). Hydrocephalus was present preoperatively in 66.7% of the patients, and a permanent shunt was required in 31.6% of the cases. The GTR procedure was feasible in 64.5%, and 93.8% showed clinical improvement. For CPPs, GTR is the gold standard treatment and should be attempted whenever feasible, especially because the role of the adjuvant treatment remains controversial. Neuromonitoring is a valuable tool to achieve maximal safe resection. Hydrocephalus is common and must be recognized and promptly treated. Most patients will need a permanent shunt. Though there is still controversy on its efficacy, endoscopic third ventriculostomy is a safe procedure, and was the authors' first choice to treat hydrocephalus.

Os papilomas do plexo coroide (PPCs) são neoplasias benignas raras e, na população pediátrica, são particularmente incomuns na fossa posterior. Apresentamos uma série de casos de cinco pacientes atendidos em um hospital terciário. Além disso, foi realizada uma ampla revisão da literatura. Os pacientes atendidos no hospital terciário tinham entre 4 e 16 anos. Ressecção macroscópica total (RMT) foi inicialmente realizada em dois pacientes. Todos os pacientes apresentaram melhora clínica. Além disso, 27 artigos publicados entre 1975 e 2021 foram selecionados para a revisão da literatura, totalizando 46 pacientes. Somados à série de casos atuais, encontramos 51 pacientes, com média de idade de 8,2 anos. As lesões localizavam-se no quarto ventrículo (65,3%) ou no ângulo pontocerebelar (34,7%). Hidrocefalia estava presente no pré-operatório em 66,7% dos pacientes, e derivação ventricular permanente foi necessária em 31,6% dos casos. A RMT foi possível em 64,5%, e 93,8% tiveram melhora clínica. Para os CPPs, a RMT é o tratamento padrão-ouro e deve ser tentado sempre que possível, especialmente porque ainda existem controvérsias quanto ao papel do tratamento adjuvante. A neuromonitorização é uma ferramenta importante para se atingir a máxima ressecção segura. A hidrocefalia é comumente vista nesses pacientes e deve ser identificada e tratada. A maioria dos pacientes irá precisar de uma derivação permanente. Apesar de persistirem controvérsias sobre sua eficácia, a terceiro-ventriculostomia endoscópica foi a primeira escolha para tratar a hidrocefalia na experiência dos autores e é uma opção segura.

Obstructive Hydrocephalus Due to Posterior Fossa Tumors in Adults: A Comparative Analysis of 3 Surgical Techniques.

BACKGROUND: The main treatments for hydrocephalus due to posterior fossa tumors are tumor resection with or without an external ventricular drain, ventriculoperitoneal shunt (VPS), and endoscopic third ventriculostomy. Although preoperative cerebrospinal fluid diversion by any of these techniques improves clinical outcomes, evidence comparing the efficacy of these techniques is scarce. Therefore, we aimed to retrospectively evaluate each treatment modality. METHODS: This single-center study analyzed 55 patients. Treatments were classified as successful (hydrocephalus resolution with a single surgical event) or failed and compared with a χ2 test. Kaplan-Meier curves and log-rank tests were employed. A Cox proportional hazard model was used to determine relevant covariates predicting outcomes. RESULTS: Mean patient age was 36.3 years, 43.4% of patients were men, and 50.9% of patients presented with uncompensated intracranial hypertension. Mean tumor volume was 33.4 cm3, and extent of resection was 90.85%. Tumor resection with or without an external ventricular drain was successful in 58.82% of cases, VPS was successful in 100%, and endoscopic third ventriculostomy was successful in 76.19% (P = 0.014). Mean follow-up time was 15.12 months. Log-rank test found statistically significant differences between survival curves of treatments (P = 0.016) favoring the VPS group. Postoperative surgical site hematoma was a significant covariate in the Cox model (hazard ratio = 17; 95% confidence ratio, 2.301-81.872; P = 0.004). CONCLUSIONS: This study favored VPS as the most reliable treatment of hydrocephalus due to posterior fossa tumors in adult patient; however, several factors influence clinical outcomes. We proposed an algorithm based on our findings and other authors' findings to facilitate the decision-making process.

[Torticolis as a form of presentation of Blake's pouch cyst. Ultrasound diagnosis in primary care]. / Tortícolis como forma de presentación de quiste de la bolsa de Blake. Diagnóstico ecográfico en atención primaria.

Torticollis is a clinical sign defined by the lateral inclination of the neck and rotation of the head, which can be fixed or flexible and accompanied or not by cervical pain. It appears in disorders of different complexity. In a case of torticollis it is necessary to carry out a careful medical history and a complete physical examination and, if persistent, request imaging tests. Reference is made to a cause of torticollis not described in the literature. This is a compressive cystic tumor in the posterior cranial fossa, Blake's pouch cyst, in a small infant diagnosed by ultrasound in the Primary Care Pediatrics office. After diagnosis, she was referred to the referral hospital, where emergency intervention was performed by pediatric neurosurgery, by fenestration of the tumor by endoscopic ventriculostomy and ventriculo-peritoneal shunt. She is currently asymptomatic and without sequelae.

La tortícolis es un signo clínico definido por la inclinación lateral del cuello y rotación de la cabeza, que puede ser fija o flexible y acompañarse o no de dolor cervical. Aparece en trastornos de diferente complejidad. Ante un caso de tortícolis, es preciso realizar una historia clínica cuidadosa y un examen físico completo, y, en caso de ser persistente, solicitar pruebas de imagen. Se hace referencia a una causa de tortícolis no descrita en la literatura. Se trata de una tumoración quística compresiva en la fosa craneal posterior, quiste de la bolsa de Blake, en una lactante pequeña diagnosticada mediante ecografía en la consulta de Pediatría de Atención Primaria. Tras el diagnóstico, se remitió al centro hospitalario de referencia, donde se intervino de urgencia por Neurocirugía Pediátrica, mediante fenestración de la tumoración por ventriculostomía endoscópica y derivación ventrículo-peritoneal. Actualmente, se encuentra asintomática y sin secuelas.

Avaliação da terceiro ventriculostomia endoscópica em lactentes: uma revisão sistemática da literatura e metanálise / Evaluation of endoscopic third ventriculostomy in infants: a systematic literature review and meta-analysis

Introdução: A hidrocefalia é um distúrbio da fisiologia do líquido cefalorraquidiano (LCR), usualmente associada ao aumento a pressão intracraniana (PIC) e expansão dos ventrículos cerebrais. Representa uma das condições mais comuns em neurocirurgia pediátrica. A terceiro ventriculostomia endoscópica (TVE) é uma opção de tratamento à hidrocefalia que visa eliminar a dependência do paciente às derivações ventrículo peritoneais. Embora a baixa idade seja associada à falha da TVE, ainda não existe consenso sobre a realização da TVE em crianças abaixo de 24 meses. Objetivos: Mensurar a taxa de falha da TVE em crianças até 24 meses; medir a associação entre menor idade, diferentes etiologias da hidrocefalia e a falha da TVE. Metodologia: Seguindo a metodologia do PRISMA-P foram identificados estudos nas bases com os descritores relacionados à TVE, falha e lactentes, sem limite de data. Várias etapas foram realizadas por dois pesquisadores de forma cega e independente. Nas leituras de resumo e texto completo aplicou-se um formulário de elegibilidade com critérios elaborados para esta RSL. Dois instrumentos - Escala de Newcastle-Ottawa e Formulário de análise de qualidade - viabilizaram a análise qualitativa que permitiu a inclusão e a extração de dados. Os testes Q e I2 avaliaram a heterogeneidade e o modelo de efeito randômico foi utilizado para o cálculo das estimativas metanalíticas. Os programas OpenMeta [Analyst] e Review Mananger versão 5.4 foram utilizados. Resultados: Foram identificados 440 estudos nas bases Pubmed, Embase e Lilacs e 1 por referência de artigo. Foram retirados 134 títulos duplicados, por não serem elegíveis 118 na leitura de resumos e 155 na leitura de textos completos. Dos 34 estudos analisados 8 foram excluídos pela análise de qualidade e após a retirada de uma coorte repetida foram incluídos 25 artigos. A taxa de falha da TVE variou de 14,6 a 77,8%. Não foi possível calcular uma estimativa sumária da taxa de falha dos estudos em função da alta heterogeneidade (I²: 82,2). Optou-se então pela metanálise em subgrupos. Não foi detectada heterogeneidade (I²=0, p=0,56) portanto, a medida metanalítica para a falha de acordo com a idade, comparando lactentes menores de 6 meses com lactentes de 6 a 24 meses foi RR=1,73 IC95%[1,22-2,45]. Ao considerar estenose de aqueduto a categoria de base para análise de outros subgrupos o RR metanalítico com significância estatística foi obtido para infecção 2,07 IC95%[1,13-3,79], para hemorragia intraventricular: 2,27 IC95%[1,40-3,68], para mielomeningocele : 2,13, IC95%[1,01-4,48]. Apesar da ausência de heterogeneidade, o RR para lesão de fossa posterior foi de 1,31 IC95%:[0,69-2,40] incluiu o valor nulo e não foi significativo (p= 0,41). A taxa de falha da repetição de TVE variou de 0-90%, as etiologias foram estenose de aqueduto, infecção, hemorragia e outros. Os principais achados na repetição do procedimento foram membrana adicional e estoma fechado. Discussão e Conclusões: A medida metanalítica sumária para taxa de falha não foi obtida devido à grande heterogeneidade dos estudos. Foram feitas tentativas de agrupamento por tamanho da casuística e por data de realização que poderiam sugerir maior domínio da técnica mas a heterogeneidade se manteve. As principais complicações relatadas foram fístula liquórica e hemorragia intraoperatória, relacionando-se com a falha da cirurgia. Não foi possível avaliar os lactentes que foram submetidos à TVE em associação com reservatório de LCR. Os resultados desta RSL e metanálise confirmam que a idade menor de 6 meses é um fator prognóstico para a falha da TVE e demonstram o valor prognóstico de outras etiologias da hidrocefalia como a infecção, a hemorragia intraventricular e a mielomeningocele onde o risco para a falha da TVE foi 2 vezes maior.

Introduction: Hydrocephalus is a disorder of the cerebrospinal fluid (CSF) physiology, usually associated with increased intracranial pressure (ICP) and expansion of the cerebral ventricles. It represents one of the most common conditions treated in pediatric neurosurgery. Third endoscopic ventriculostomy (ETV) is a treatment option for hydrocephalus that aims to eliminate the patient's dependence on shunt. Young age is associated with surgery failure, and it is not clear whether or not ETV should be performed in children under 24 months old. Objectives: Measure the failure rate of TVE in children under 24 months old; measure is a relation between failure and younger age and hydrocephalus etiology. Methodology: This review was developed observing the parameters of the PRISMA-P guidelines. Systematic search using PubMed Embase and Lilacs using respective entry terms for each mesh terms ETV, failure and infants was carried out. the articles were chosen by reading abstracts, full text, applying the eligibility form and quality analysis - newcastle scale and quality form. The data were analyzed in OpenMeta[Analyst] and Review Mananger version 5.4, The Q and I² tests and random effect model were used to derive the meta-analytic estimates. Results: 440 studies were identified in Pubmed, Embase and Lilacs databases and 1 by article reference. 134 duplicates were removed, as 118 were not eligible when reading abstracts and 155 when reading full text. Of the 34 studies analyzed, 8 were excluded by the quality analysis and, after the removal of a repeated cohort e cohort, 25 articles were included. The failure rate of TVE ranged from 14.6 to 77.8%. It was not possible to calculate a summary estimate of the failure rate of the studies due to the high heterogeneity (I²: 82.2). Subgroup analysis was chosen The RR for age 1.73 CI95%:[1.22-2.45]; the RR for etiology, comparing each onde with aqueduct stenosis, were: infection 2.07 CI95%[1.13-3.79], intraventricular hemorrhage RR: 2.27 CI95%[1.40-3.68], RR for spinal dysraphism: 2.13 CI95%[1.01-4.48]. The RR for posterior fossa-space occupying lesions was 1.31 IC95%:[0.69-2.40], and not statistically significant. The failure rate for re-do ETV ranged from 0- to 90%, the re-do ETV etiologies were aqueduct stenosis, intraventricular infection, hemorrhage and others. The main intraoperative findings were extra membrane and closed stoma. Discussion and Conclusions: Due to the great heterogeneity of the sample, it was not possible to calculate the failure rate of infants. The most reported complications were CSF fistula and hemorrhage, related to the failure of the surgery. It was not possible to evaluate infants who underwent ETV in association with a CSF reservoir. The results of this systematic review and meta-analysis confirm that the age untill 6 months old is a prognostic factor for the failure of ETV and demonstrate the prognostic value of other aetiologies of hydrocephalus such as infection, intraventricular hemorrhage and myelomeningocele, in which the risk for ETV failure was 2 times higher.

Migration of Oxidized Cellulose to the Ventricle as a Complication of Endoscopic Third Ventriculostomy: A Case Report

Endoscopic third ventriculostomy (ETV) is an increasingly common neurosurgical procedure. Hemostatic agentes (porcine gelatin and oxidized cellulose) are normally placed to plug the cortical hole after ETV to avoid cerebral spinal fluid leakage, subdural hygroma, and hemorrhage. Here we report the case of a 6-year-old boy with hydrocephalus who underwent ETV and which oxidized cellulose was placed to plug the cortical hole.Magnetic resonance imaging of the head performed 3 months after the procedure showed the presence of oxidized cellulose in the ventricle. After an unsuccessful attempt to remove the cellulose, it was decided that the patient should be kept under observation. Twoyears later, the child is in good health and without any complaints. Hemostatic agents (especially oxidized cellulose) used on the cortical hole after ETV can migrate to the ventricle and compromise the procedure. Follow-up should be performedfor such patients, and the main focus should be on not causing further injury.

Endoscopic ventriculo-cisterno-ventricular approach in the treatment of bilateral trapped temporal horn related to fungal infection in a child: case report and review of the literature.

INTRODUCTION: Focal hydrocephalus including trapped temporal horn (TTH), isolated lateral and fourth ventricles, is caused by obstruction and/or adhesion related to various etiologies. With the advent of the neuroendoscope, endoscopic procedures have become an alternative in selected cases. CASE REPORT: A 2-year-old male from a rural town in México was referred to our institution because of multiple supra- and infra-tentorial abscesses and hydrocephalus. The patient had progressive deterioration and developed bilateral trapped temporal horn related to multi-septated hydrocephalus, so we performed an endoscopic ventricular-cistern-ventriculostomy through a single right temporal burr hole. POSTOPERATIVE COURSE: Bilateral TTH and multi-septated hydrocephalus were effectively treated with a single external ventricular drainage (EVD) catheter, from the right temporal horn to the left temporal horn through the interpeduncular cistern; after clamping the EVD for 3 days with no evidence of hydrocephalus, the EVD was removed. The size of the ventricles remained stable afterwards, and no clinical or radiological evidence of hydrocephalus was observed after 3 months of follow-up. DISCUSSION: Endoscopic ventriculocisternostomy is effective in selected cases of TTH. We know that dilatation of the temporal horn widens the window between the anterior choroidal artery and optic tract superiorly, and the posterior communicating and CN III inferiorly, making the described procedure feasible, even in the approach to the contralateral side. Even though this is a rare condition, we believe it is a safe and effective option to eliminate multiple shunts and/or to reduce the number of catheters needed to treat bilateral THH related to multi-septated hydrocephalus.

Tratamiento endoscópico de quistes coloideos del tercer ventrículo / Third ventricle colloid cysts endoscopic approach

Introducción: los quistes coloideos (QC) son tumores benignos de crecimiento lento, que comprenden menos del 1% de los tumores intracraneales. Se presentan en adultos jóvenes y se ubican más frecuentemente en el techo del tercer ventrículo. El objetivo de este trabajo es presentar una serie de pacientes con QC del tercer ventrículo operados por vía endoscópica, analizar la técnica quirúrgica, ventajas y desventajas. Desarrollo: se realizó una búsqueda retrospectiva de pacientes operados por vía endoscópica, en el Servicio de Neurocirugía del Hospital Italiano de Buenos Aires, de tumores del tercer ventrículo en un período de 2 años (2013-2015), con diagnóstico de QC confirmado por anatomía patológica . Se identificaron cinco pacientes, tres mujeres y dos hombres, cuyo promedio de edad fue de 50 años. No hubo complicaciones perioperatorias y ninguno mostró recidiva en el lapso de observación. Conclusión: la vía endoscópica es una vía técnicamente simple y con muy baja morbilidad. Si bien no siempre puede realizarse una exéresis completa, los trabajos prospectivos permitirán definir si esto resulta suficiente para el control de la enfermedad. (AU)

Colloid cysts are benign, slow-growing tumors, comprising less than 1% of intracranial tumors. They occur in young adults and are more frequently located on the roof of the third ventricle. The objective of this study is to present a series of patients with Colloid cysts operated endoscopically and analyze advantages and disadvantages of this surgical technique. We performed a retrospective review of Colloid Cysts operated on endoscopically, at the Neurosurgical Department of Hospital Italiano de Buenos Aires in a period of 2 years (2013-2015). Five patients were identified, three women and two men whose average age was 50 years. No perioperative complications were observed, with no recurrences during the follow up period. Conclusion: the endoscopic approach is technically simple and has very low morbidity. Although a complete excision can not always be performed, prospective studies will allow us to define whether if is sufficient to control the disease. (AU)

Bobble-head doll syndrome in an 80-year-old man, associated with a giant arachnoid cyst of the lamina quadrigemina, treated with endoscopic ventriculocystocisternotomy and cystoperitoneal shunt.

Bobble-head doll syndrome (BHDS) is a rare entity, characterized by antero-posterior head bobbing, which is of the type "yes-yes." Less frequently, having a head movement of the type "no-no" is described. We report an unusual case of an 80-year-old man with a cystic mass of the lamina quadrigemina, extending to the posterior fossa. We conclude that ventriculocystocisternotomy associated with a cystoperitoneal shunt is an effective treatment for a symptomatic giant arachnoid cyst in the lamina quadrigemina.

Embriología del sistema ventricular cerebral / Cerebral ventricular system embryology

El Sistema Ventricular Cerebral se desarrolla de forma paralela al resto del Sistema Nervioso Central, facilitando la circulación del Líquido Cefalorraquídeo, desde su separación del líquido amniótico a nivel embrionario. Este desarrollo es necesario para entender correctamente la anatomía ventricular y facilitar el abordaje para patologías intraventriculares. El objetivo de esta revisión es reconocer los puntos más importantes en la embriología ventricular para facilitar el aprendizaje de la anatomía quirúrgica ventricular.

The cerebral ventricular system is developed in parallel with the rest of the central nervous system, facilitating the circulation of cerebrospinal fluid, from the amniotic fluid separation in the embryonic phases. This development is necessary to correctly understand the ventricular anatomy and facilitate approach to intraventricular pathologies. The objective of this review is to recognize the most important points in the ventricular embryology and in the intraventricular endoscopic vision to facilitate learning of the ventricular surgical anatomy.

Choroid plexus coagulation for pediatric hydrocephalus: review of historical aspects and rebirth

This study aims to review historical aspects and rebirth of the endoscopic choroid plexus coagulation (CPC) for pediatric hydrocephalus. The first CPC procedure goes back to early 1930s. After the development of other treatment methods and the understanding of CSF dynamics, the application of CPC dramatically decreased by 1970s. In 2000s, there was a rebirth of CPC in combination with endoscopic third ventriculostomy (ETV), and remains one of the options for the treatment of pediatric hydrocephalus in selected cases. CPC might provide a temporary reduction in CSF production to allow the further development of CSF absorption in infant, and adding to ETV for infants with communicating hydrocephalus may increase the shunt independent rate thus avoiding the consequence of late complication related to the shunt device. This is important for patients who are difficult to be followed up, due to geographical and/or socioeconomic difficulties. And also adding CPC to ETV for obstructive hydrocephalus in infants younger than 1 year of age may also increase the successful rate. Furthermore, CPC may be an option for cases with high chance of shunt complication such as multiloculated hydrocephalus, extreme hydrocephalus and hydranencephaly. In comparison with the traditional treatment of CSF shunting, the role of CPC needs to be further evaluated in particular concerning the neurocognitive development.

Endoscopic transventricular exploration with biopsy of the basal cisterns and the role of endoscopic third ventriculostomy in patients suffering with basal cistern meningitis and consecutive hydrocephalus.

OBJECTIVES: The purpose of this work is to elucidate the efficacy of endoscopic basal cisterns exploration, biopsy, and third ventriculostomy (ETV) in patients with basal cistern meningitis and arachnoiditis. MATERIALS AND METHODS: The cases and videos of all patients in whom flexible neuroendoscopy was performed during the period of January 2005-June 2012 at the University Hospital 'Dr. Ignacio Morones Prieto' in San Luis Potosí, México. A group of 47 patients with radiological diagnosis of basal meningitis, arachnoiditis, and negative cerebrospinal fluid analysis were included. RESULTS: From the 28 (60%) patients with histological diagnosis, 22 (47%) were made from biopsy from the arachnoid membranes of the basal cisterns only, 4 (9%) only from the cerebral cortex, and 2 (4%) from both sites. There were no complications related to the endoscopic procedure. In 23 patients from the 42 with hydrocephalus, ETV was successful. The grade of diagnostic accuracy of both biopsies in detect etiology was 68% (28 of 47 patients), the diagnostic accuracy of arachnoid biopsy was 60%, and diagnostic accuracy of convexity brain biopsy was 21% with 24 and 6 patients, respectively. DISCUSSION: Endoscopic transventricular biopsy of the basal cisterns seems to be a safe and a relatively accurate procedure. As longs as frozen subarachnoid space was not seen, the possibilities of performing ETV in hydrocephalus condition are elevated depending on the causal micro-organism.

Evidences in the treatment of idiopathic normal pressure hydrocephalus.

INTRODUCTION: idiopathic normal pressure hydrocephalus (INPH) is characterized by gait apraxia, cognitive dysfunction and urinary incontinence. There are two main treatment options: ventriculoperitoneal shunt (VPS) and endoscopic third ventriculostomy (ETV). However, there are doubts about which modality is superior and what type of valve should be applied. We are summarizing the current evidence in INPH treatment. METHODS: an electronic search of the literature was conducted on the Medline, Embase, Scielo and Lilacs databases from 1966 to the present to obtain data published about INPH treatment. RESULTS: the treatment is based on three pillars: conservative, ETV and VPS. The conservative option has fallen into disuse after various studies showing good results after surgical intervention. ETV is an acceptable mode of treatment, but the superiority of VPS has made the latter the gold standard. CONCLUSION: well-designed studies with a high level of appropriate evidence are still scarce, but the current gold standard for treatment of INPH is conducted using VPS.

Evidences in the treatment of idiopathic normal pressure hydrocephalus / Evidências no tratamento da hidrocefalia de pressão normal idiopática.

Summary Introduction: idiopathic normal pressure hydrocephalus (INPH) is characterized by gait apraxia, cognitive dysfunction and urinary incontinence. There are two main treatment options: ventriculoperitoneal shunt (VPS) and endoscopic third ventriculostomy (ETV). However, there are doubts about which modality is superior and what type of valve should be applied. We are summarizing the current evidence in INPH treatment. Methods: an electronic search of the literature was conducted on the Medline, Embase, Scielo and Lilacs databases from 1966 to the present to obtain data published about INPH treatment. Results: the treatment is based on three pillars: conservative, ETV and VPS. The conservative option has fallen into disuse after various studies showing good results after surgical intervention. ETV is an acceptable mode of treatment, but the superiority of VPS has made the latter the gold standard. Conclusion: well-designed studies with a high level of appropriate evidence are still scarce, but the current gold standard for treatment of INPH is conducted using VPS. .

Resumo Introdução: a hidrocefalia de pressão normal idiopática (HPNI) é caracterizada por apraxia da marcha, disfunção cognitiva e incontinência urinária. Existem duas principais opções terapêuticas: derivação ventriculoperitoneal (DVP) e terceiro ventriculostomia endoscópica (TVE). No entanto, há dúvidas sobre qual modalidade é superior e que tipo de válvula deve ser aplicada. Este artigo resume as evidências atuais no tratamento de HPNI. Métodos: uma busca eletrônica da literatura foi realizada nas bases de dados Medline, Embase, SciELO e Lilacs, de 1966 até o momento presente para revelar os dados publicados sobre o tratamento da HPNI. Resultados: o tratamento é baseado em três pilares: conservador isolado, TVE e DVP. A opção conservadora caiu em desuso depois de vários estudos revelarem bons resultados após a intervenção cirúrgica. A TVE é uma modalidade de tratamento aceitável, mas a superioridade da DVP torna-a o padrão-ouro. Conclusão: estudos com evidência de alto nível, adequados e bem desenhados, ainda são escassos. O tratamento padrão-ouro atual de HPNI é realizado com DVP. .

[Endoscopic third ventriculostomy for chronic communicating hydrocephalus in adults]. / Tercer ventriculostomía endoscópica secundaria en hidrocefalia comunicante crónica en el adulto.

BACKGROUND: Shunt devices to treat hydrocephalus are associated with a malfunction of 81 % at 12 years and 10 % of infection. The objective was to assess safeness and efficacy of endoscopic third ventriculostomy (ETV) for the treatment of chronic communicating hydrocephalus. METHODS: Eight patients with chronic communicating hydrocephalus were included in a period between September, 2012 and April, 2013. X ray computed tomography scans were performed when patients were admitted, after the surgery, and at 30, 180 and 365 days. The follow-up was of 251 days (the biggest was of 459 days). The variables included were: age, sex, etiology, time of evolution, and the total number of shunt malfunctions. Conventional technique with a 30° rigid endoscope was performed, malfunctional shunt was removed, and a tied shunt device was placed. RESULTS: Four males and four females, with a mean age of 42 years (27-63 years); neurocysticercosis was identified in five patients (62.5 %); the evolution rate was of 18 years (15-30 years); the hospital stay rate was of 6.5 days (3-22 days); the mean of previous shunt malfunctions was 4 (1-6). COMPLICATIONS: neuroinfection in one patient, malfunction in three patients. None of them died. CONCLUSIONS: ETV is a safety procedure for treating chronic communicating hydrocephalus; it has a success rate higher than 60 %. Neurocysticercosis showed better results when previous shunt malfunctions were lower than three.

Introducción: la derivación valvular para tratar la hidrocefalia se asocia con disfunción del 81 % a 12 años y 10 % de infección. El objetivo es evaluar la seguridad y la eficacia clínica de la tercer ventriculostomía endoscópica secundaria (TVE) en pacientes con hidrocefalia comunicante crónica. Métodos: se incluyeron ocho pacientes adultos entre septiembre de 2012 y abril de 2013 con hidrocefalia por disfunción valvular de etiología comunicante. Se les hizo estudio de tomografía axial computarizada al ingreso, postoperatoria, y después de 30, 180 y 365 días. El seguimiento clínico fue de 251 días (el mayor fue de 459 días). Las variables incluidas fueron: edad, sexo, etiología, tiempo de evolución y número de sistemas valvulares fallidos. Se aplicó técnica convencional con endoscopio rígido 30°, retiro de catéter disfuncional, y colocación de sistema valvular ligado. Resultados: cuatro hombres y cuatro mujeres, con edad promedio de 42 años (27-63 años), neurocisticercosis en cinco pacientes (62.5 %), evolución promedio de 18 años (15-30 años), estancia hospitalaria promedio 6.5 días (3-22días), disfunciones valvulares previas promedio 4 (1-6). Complicaciones: hubo neuroinfección en un paciente y disfunción en tres pacientes. Ninguno murió. Conclusión: la TVE secundaria es un procedimiento seguro en el tratamiento de hidrocefalia comunicante crónica, con una eficacia mayor al 60 %. En neurocisticercosis se observaron mejores resultados con antecedente de dos o menos recambios valvulares.

Endoscopic approach for the treatment of pineal region tumors.

Tumors of the pineal region account for 3 to 8% of the tumors involving the central nervous system. The most common are germ cell tumors (39%). Less common examples include teratomas, primitive neuroectodermic tumors, astrocytomas, and choriocarcinomas. Clinical presentation in pediatric patients is in direct relation to the anatomical structures surrounding the pineal region and to the associated hydrocephalus that is present in almost 90% of cases. The diagnosis of a tumor in the pineal region is based on radiological findings and the presence of tumor markers such as α-fetoprotein and human chorionic gonadotrophic hormone subfraction ß. Neuroendoscopy is considered to be one of the minimally invasive techniques useful for the management of such patients. This minimally invasive approach to pineal region tumors allows the treatment of hydrocephalus in a safe and effective way, avoiding the complications derived from other procedures such as external ventricular drainage or shunt surgery.

Endoscopic third ventriculostomy has no higher costs than ventriculoperitoneal shunt.

OBJECTIVE: To evaluate the cost of endoscopic third ventriculostomy (ETV) compared to ventriculoperitoneal shunt (VPS) in the treatment of hydrocephalus in children. METHOD: We studied 103 children with hydrocephalus, 52 of which were treated with ETV and 51 with VPS in a prospective cohort. Treatment costs were compared within the first year after surgery, including subsequent surgery or hospitalization. RESULTS: Twenty (38.4%) of the 52 children treated with VPS needed another procedure due to shunt failure, compared to 11 (21.5%) of 51 children in the ETV group. The average costs per patient in the group treated with ETV was USD$ 2,177,66±517.73 compared to USD$ 2,890.68±2,835.02 for the VPS group. CONCLUSIONS: In this series there was no significant difference in costs between the ETV and VPS groups.