Open third ventriculostomy in children: an alternate surgical strategy to ETV
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LETTER TO THE EDITOR
Open third ventriculostomy in children: an alternate surgical strategy to ETV Stephanie Anetsberger 1 & Roy Thomas Daniel 1 & Mahmoud Messerer 1 Received: 30 April 2020 / Accepted: 8 May 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Dear Editor, We read with great interest the article by Jonathan Roth and Shlomi Constantini titled “Aborting a neurosurgical procedure: analyzing the decision factors, with endoscopic third ventriculostomy as a model” [1]. This article draws the reader’s attention to the important and often overlooked topic of changing intraoperative strategy or aborting a procedure without achieving the preoperative goal of performing an endoscopic third ventriculostomy (ETV) for hydrocephalus. The authors noted that despite the role of ETV as the treatment of choice for obstructive hydrocephalus, preoperative and intraoperative factors impact the feasibility of an ETV. Non-favorable anatomy with a small prepontine space bearing the risk of basilar artery injury or small ventricle size may limit surgical success. A thick floor of the third ventricle, prepontine vessels, or adhesions as well as blurry vision due to intraventricular bleeding might also impede a ventriculostomy. These conditions warrant a change of operative strategy which may yield VPshunt implantation or insertion of an external ventricular drain (EVD). We would like to point to another treatment option in such circumstance, the open third ventriculostomy. The opening of
* Mahmoud Messerer [email protected] 1
Department of Neurosurgery, Department of Neuroscience, Centre Hospitalier Universitaire Vaudois, University Hospital Lausanne, Rue Du Bugnon 46, CH-1010 Lausanne, Switzerland
the lamina terminalis via a small frontotemporal craniotomy remains an excellent alternative to treat obstructive hydrocephalus especially if it is secondary to a tumor like a large pineal germinoma, displacing the brainstem anteriorly and leading to an effacement of the prepontine space, making ETV impossible (Fig. 1). In such a case, opening the lamina terminalis and the membrane of Liliequist via a craniotomy yielded resolution of the hydrocephalus and elevated intracranial pressure, and permitted avoidance of a permanent VP-shunt, EVD, or Rickham Reservoir, which would be dispensable after adjuvant tumor treatment. As the colleagues Roth and Constantini stated in their article, it is of paramount importance to consider and discuss the risks and alternatives of a procedure with patients and parents. A surgeon must also be prepared for eventual changes in surgical strategy. Aborting a neurosurgical procedure and changing a treatment strategy is a multifactorial process, and the alternative surgical approaches must be part of the surgical preparation. Endoscopic third ventriculostomy is an excellent example of a surgical procedure during which intraoperative challenges may require conversion of the procedure to a shunt implantation or an EVD
Childs Nerv Syst
Compliance with ethical standards Conflicts
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