Endoscopic septostomy through a standard precoronal ventricular access: Feasibility and effectiveness

Gianpiero Tamburrini, Paolo Frassanito, Luca Massimi, Massimo Caldarelli, Concezio Di Rocco

Research output: Contribution to journalArticle

Abstract

Background Although endoscopic septostomy is widely adopted in the treatment of unilateral or specific types of hydrocephalus, there is no consensus on surgical indications, technical aspects and postoperative outcome. In particular, the choice of the ventricular access has been recently debated. We investigated the results of endoscopic septostomy performed through a standard precoronal ventricular access using a rigid endoscope. Methods Patients who underwent an endoscopic septostomy at our Institution from March 2001 to March 2011 were retrospectively identified. Clinico-radiological data and video recordings of the endoscopic procedures were reviewed. Results Sixty-three patients (50 children and 13 adults) were collected. In adults, the obstruction of the cerebrospinal fluid (CSF) pathway was exclusively secondary to a tumor (neoplastic or pseudoneoplastic lesion). In the pediatric group hydrocephalus was most commonly due to a neoplasm (33 out of 50 patients), post-hemorrhagic and/or post-infectious hydrocephalus affecting 11 children and malformative hydrocephalus the remaining six children. We were able to perform the septostomy in all but two patients, presenting with a scarred multilayered septum secondary to post-hemorrhagic hydrocephalus. In 37 cases, one or more other endoscopic procedures were performed contemporarily. The mean follow-up was 24 months (min-max: 5- 96 months). Overall, all but one patient benefited clinically and radiologically from the endoscopic septostomy. Two patients harboring a pineal/mesencephalic tumor experienced a late obstruction of the stoma secondary to neoplastic infiltration of the septum. Conclusions Endoscopic septostomy can be safely performed through a standard burr-hole. The effectiveness of this approach is testified by an early success rate of more than 95% and a long term success rate of 92%.

Original languageEnglish
Pages (from-to)1517-1522
Number of pages6
JournalActa Neurochirurgica
Volume154
Issue number8
DOIs
Publication statusPublished - Aug 2012

Fingerprint

Hydrocephalus
Pinealoma
Video Recording
Endoscopes
Cerebrospinal Fluid
Neoplasms
Pediatrics
Therapeutics

Keywords

  • Cyst of the septumpellucidum
  • Endoscopic septostomy
  • Fenestration of the septum
  • Isolated ventricle
  • Neuroendoscopy
  • Precoronal burr-hole
  • Septum pellucidum

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Endoscopic septostomy through a standard precoronal ventricular access : Feasibility and effectiveness. / Tamburrini, Gianpiero; Frassanito, Paolo; Massimi, Luca; Caldarelli, Massimo; Di Rocco, Concezio.

In: Acta Neurochirurgica, Vol. 154, No. 8, 08.2012, p. 1517-1522.

Research output: Contribution to journalArticle

Tamburrini, G, Frassanito, P, Massimi, L, Caldarelli, M & Di Rocco, C 2012, 'Endoscopic septostomy through a standard precoronal ventricular access: Feasibility and effectiveness', Acta Neurochirurgica, vol. 154, no. 8, pp. 1517-1522. https://doi.org/10.1007/s00701-012-1381-6
Tamburrini, Gianpiero ; Frassanito, Paolo ; Massimi, Luca ; Caldarelli, Massimo ; Di Rocco, Concezio. / Endoscopic septostomy through a standard precoronal ventricular access : Feasibility and effectiveness. In: Acta Neurochirurgica. 2012 ; Vol. 154, No. 8. pp. 1517-1522.
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AU - Tamburrini, Gianpiero

AU - Frassanito, Paolo

AU - Massimi, Luca

AU - Caldarelli, Massimo

AU - Di Rocco, Concezio

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N2 - Background Although endoscopic septostomy is widely adopted in the treatment of unilateral or specific types of hydrocephalus, there is no consensus on surgical indications, technical aspects and postoperative outcome. In particular, the choice of the ventricular access has been recently debated. We investigated the results of endoscopic septostomy performed through a standard precoronal ventricular access using a rigid endoscope. Methods Patients who underwent an endoscopic septostomy at our Institution from March 2001 to March 2011 were retrospectively identified. Clinico-radiological data and video recordings of the endoscopic procedures were reviewed. Results Sixty-three patients (50 children and 13 adults) were collected. In adults, the obstruction of the cerebrospinal fluid (CSF) pathway was exclusively secondary to a tumor (neoplastic or pseudoneoplastic lesion). In the pediatric group hydrocephalus was most commonly due to a neoplasm (33 out of 50 patients), post-hemorrhagic and/or post-infectious hydrocephalus affecting 11 children and malformative hydrocephalus the remaining six children. We were able to perform the septostomy in all but two patients, presenting with a scarred multilayered septum secondary to post-hemorrhagic hydrocephalus. In 37 cases, one or more other endoscopic procedures were performed contemporarily. The mean follow-up was 24 months (min-max: 5- 96 months). Overall, all but one patient benefited clinically and radiologically from the endoscopic septostomy. Two patients harboring a pineal/mesencephalic tumor experienced a late obstruction of the stoma secondary to neoplastic infiltration of the septum. Conclusions Endoscopic septostomy can be safely performed through a standard burr-hole. The effectiveness of this approach is testified by an early success rate of more than 95% and a long term success rate of 92%.

AB - Background Although endoscopic septostomy is widely adopted in the treatment of unilateral or specific types of hydrocephalus, there is no consensus on surgical indications, technical aspects and postoperative outcome. In particular, the choice of the ventricular access has been recently debated. We investigated the results of endoscopic septostomy performed through a standard precoronal ventricular access using a rigid endoscope. Methods Patients who underwent an endoscopic septostomy at our Institution from March 2001 to March 2011 were retrospectively identified. Clinico-radiological data and video recordings of the endoscopic procedures were reviewed. Results Sixty-three patients (50 children and 13 adults) were collected. In adults, the obstruction of the cerebrospinal fluid (CSF) pathway was exclusively secondary to a tumor (neoplastic or pseudoneoplastic lesion). In the pediatric group hydrocephalus was most commonly due to a neoplasm (33 out of 50 patients), post-hemorrhagic and/or post-infectious hydrocephalus affecting 11 children and malformative hydrocephalus the remaining six children. We were able to perform the septostomy in all but two patients, presenting with a scarred multilayered septum secondary to post-hemorrhagic hydrocephalus. In 37 cases, one or more other endoscopic procedures were performed contemporarily. The mean follow-up was 24 months (min-max: 5- 96 months). Overall, all but one patient benefited clinically and radiologically from the endoscopic septostomy. Two patients harboring a pineal/mesencephalic tumor experienced a late obstruction of the stoma secondary to neoplastic infiltration of the septum. Conclusions Endoscopic septostomy can be safely performed through a standard burr-hole. The effectiveness of this approach is testified by an early success rate of more than 95% and a long term success rate of 92%.

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