Endoscopic third ventriculostomy versus ventriculoperitoneal shunt in the treatment of obstructive hydrocephalus due to posterior fossa tumors in children
- نوع فایل : کتاب
- زبان : انگلیسی
- مؤلف : Nasser M. F. El-Ghandour
- چاپ و سال / کشور: 2010
Description
Object This study compares endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunt (VPS) in the treatment of pediatric patients with marked obstructive hydrocephalus due to midline posterior fossa tumors. Methods Fifty-three pediatric patients with a midline posterior fossa tumor (32 medulloblastomas and 21 ependymomas) associated with marked hydrocephalus were studied. Patients were divided into two groups: group A (32 patients) operated by ETV with a mean follow-up of 27.4 months and group B (21 patients) operated by VPS with a mean follow-up of 25 months. Results Both procedures proved to be effective clinically and radiologically. In group A, intraoperative bleeding occurred in two cases (6.2%) and cerebrospinal fluid leakage in one case (3.1%). In group B, shunt infection occurred in two cases (9.4%), one of these two cases died 4.5 months postoperatively from ventriculitis. Subdural collection occurred in two cases (9.4%), epidural hematoma in one case (4.7%), and upward brain herniation in one case (4.7%). Endoscopic third ventriculostomy proved to be superior due to shorter duration of surgery (15 min versus 35 min), lower incidence of morbidity (9.3% versus 38%), no mortality (0% versus 4.7%), and lower incidence of procedure failure (6.2% versus 38%). Conclusion The shorter duration of surgery, the lower incidence of morbidity, the absence of mortality, the lower incidence of procedure failure, and the significant advantage of not becoming shunt dependent make ETV be recommended as the first choice in the treatment of pediatric patients with marked obstructive hydrocephalus due to midline posterior fossa tumors
Childs Nerv Syst (2011) 27:117–126 DOI 10.1007/s00381-010-1263-2 Received: 7 May 2010 / Accepted: 2 August 2010 / Published online: 25 August 2010
