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Endoscopic Third Ventriculostomy: Role of Image Guidance in Reducing the Complications

INTRODUCTION: Endoscopic third ventriculostomy (ETV) is performed by neurosurgeons around the world for the management of hydrocephalus. ETV has been associated with multiple complications, the most significant being iatrogenic injury to the fornix. We aim to establish the fact that the use of image...

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Autores principales: Wasi, Muhammad Samir Irfan, Sharif, Salman, Shaikh, Yousuf
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer - Medknow 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7869306/
https://www.ncbi.nlm.nih.gov/pubmed/33708664
http://dx.doi.org/10.4103/ajns.AJNS_161_20
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author Wasi, Muhammad Samir Irfan
Sharif, Salman
Shaikh, Yousuf
author_facet Wasi, Muhammad Samir Irfan
Sharif, Salman
Shaikh, Yousuf
author_sort Wasi, Muhammad Samir Irfan
collection PubMed
description INTRODUCTION: Endoscopic third ventriculostomy (ETV) is performed by neurosurgeons around the world for the management of hydrocephalus. ETV has been associated with multiple complications, the most significant being iatrogenic injury to the fornix. We aim to establish the fact that the use of image guidance while planning a trajectory can reduce the incidence of complications as it significantly alters the usual approach for ETV, i.e., the coronal burr hole can be useful for young neurosurgeons to overcome the learning curve associated with the procedure. MATERIALS AND METHODS: This is a prospective, observational study conducted at Liaquat National Hospital. In this study, 43 patients were included who underwent ETV for hydrocephalus. Complications were divided into three major groups: arterial hemorrhage, venous hemorrhage, and injury to neural structures (fornix, hypothalamus, and oculomotor nerve). The data were compared with studies showing the complications of ETV with and without usage of image guidance. RESULTS: Among the 43 patients who underwent ETV with image guidance, only two patients (4.65%) had iatrogenic fornix contusions. Neither of them developed memory impairment. None of the patients (0%) encountered other major iatrogenic complications, including injury to the mammillary body, basilar artery, or oculomotor nerve. CONCLUSION: The use of image guidance can reduce trajectory-related complications, including hemorrhage and iatrogenic injuries to the fornix. This study showed that the altered trajectory was beneficial in avoiding major neurological structures while introducing an endoscope through the cortex into the ventricular system.
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spelling pubmed-78693062021-03-10 Endoscopic Third Ventriculostomy: Role of Image Guidance in Reducing the Complications Wasi, Muhammad Samir Irfan Sharif, Salman Shaikh, Yousuf Asian J Neurosurg Original Article INTRODUCTION: Endoscopic third ventriculostomy (ETV) is performed by neurosurgeons around the world for the management of hydrocephalus. ETV has been associated with multiple complications, the most significant being iatrogenic injury to the fornix. We aim to establish the fact that the use of image guidance while planning a trajectory can reduce the incidence of complications as it significantly alters the usual approach for ETV, i.e., the coronal burr hole can be useful for young neurosurgeons to overcome the learning curve associated with the procedure. MATERIALS AND METHODS: This is a prospective, observational study conducted at Liaquat National Hospital. In this study, 43 patients were included who underwent ETV for hydrocephalus. Complications were divided into three major groups: arterial hemorrhage, venous hemorrhage, and injury to neural structures (fornix, hypothalamus, and oculomotor nerve). The data were compared with studies showing the complications of ETV with and without usage of image guidance. RESULTS: Among the 43 patients who underwent ETV with image guidance, only two patients (4.65%) had iatrogenic fornix contusions. Neither of them developed memory impairment. None of the patients (0%) encountered other major iatrogenic complications, including injury to the mammillary body, basilar artery, or oculomotor nerve. CONCLUSION: The use of image guidance can reduce trajectory-related complications, including hemorrhage and iatrogenic injuries to the fornix. This study showed that the altered trajectory was beneficial in avoiding major neurological structures while introducing an endoscope through the cortex into the ventricular system. Wolters Kluwer - Medknow 2020-10-19 /pmc/articles/PMC7869306/ /pubmed/33708664 http://dx.doi.org/10.4103/ajns.AJNS_161_20 Text en Copyright: © 2020 Asian Journal of Neurosurgery http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Original Article
Wasi, Muhammad Samir Irfan
Sharif, Salman
Shaikh, Yousuf
Endoscopic Third Ventriculostomy: Role of Image Guidance in Reducing the Complications
title Endoscopic Third Ventriculostomy: Role of Image Guidance in Reducing the Complications
title_full Endoscopic Third Ventriculostomy: Role of Image Guidance in Reducing the Complications
title_fullStr Endoscopic Third Ventriculostomy: Role of Image Guidance in Reducing the Complications
title_full_unstemmed Endoscopic Third Ventriculostomy: Role of Image Guidance in Reducing the Complications
title_short Endoscopic Third Ventriculostomy: Role of Image Guidance in Reducing the Complications
title_sort endoscopic third ventriculostomy: role of image guidance in reducing the complications
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7869306/
https://www.ncbi.nlm.nih.gov/pubmed/33708664
http://dx.doi.org/10.4103/ajns.AJNS_161_20
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