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Improved Turnaround Times | Median time to first decision: 12 days

Research ArticleAdult Brain

Natural History of Endoscopic Third Ventriculostomy in Adults: Serial Evaluation with High-Resolution CISS

M. Trelles, A.K. Ahmed, C.H. Mitchell, I. Josue-Torres, D. Rigamonti and A.M. Blitz
American Journal of Neuroradiology December 2018, 39 (12) 2231-2236; DOI: https://doi.org/10.3174/ajnr.A5861
M. Trelles
aFrom the Departments of Radiology and Radiological Sciences (M.T., A.M.B.)
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A.K. Ahmed
bNeurosurgery (A.K.A., I.J.-T., D.R.)
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C.H. Mitchell
cNeurology (C.H.M.), Johns Hopkins University School of Medicine, Baltimore, Maryland.
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I. Josue-Torres
bNeurosurgery (A.K.A., I.J.-T., D.R.)
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D. Rigamonti
bNeurosurgery (A.K.A., I.J.-T., D.R.)
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A.M. Blitz
aFrom the Departments of Radiology and Radiological Sciences (M.T., A.M.B.)
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Article Figures & Data

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  • Fig 1.
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    Fig 1.

    Representative sagittal CISS image and coronal MPR reconstruction of a third ventriculostomy defect with anteroposterior and third ventriculostomy defect size measurement.

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    Fig 2.

    Defect size area across time after surgery.

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    Fig 3.

    Representative case showing presurgical imaging, first follow-up at 1 day postsurgery, and final follow-up at 421 days postsurgery showing an increase in the ETV defect size.

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    Fig 4.

    Average increase in the size of the defect across time.

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    Fig 5.

    Maximum defect size and age at the operation.

Tables

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    Table 1:

    Demographic information

    Demographics%No.
    Sex
        Male44%15
        Female56%19
    Mean age (range) (yr)54 (19–76)
    • View popup
    Table 2:

    Site of obstruction to the flow of CSF

    Location of Obstruction%No.
    Cerebral aqueduct82%28
    Fourth ventricle outflow3%1
    Prepontine cistern9%3
    Unknown3%1
    Other3%1
    34
    • View popup
    Table 3:

    Average defect size ± 95% confidence interval and t test for the NICO Myriad device at last follow-up

    NICO Myriad Device Used
    YesNoP Value
    Average defect size at LFU (mean)28.21 ± 7.4811.25 ± 6.80<.05
    • Note:—LFU indicates last follow-up.

    • View popup
    Table 4:

    Presenting symptoms

    NICO Myriad UsedNo NICO MyriadP Value
    Headache60%75%>.05
    Dizziness26.7%30%>.05
    Nausea26.7%35%>.05
    Vision deficit40%45%>.05
    Gait abnormality53.3%50%>.05
    Urinary incontinence46.7%35%>.05
    Cognitive dysfunction53.3%60%>.05
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    Table 5:

    Clinical outcomes at 6 months and last follow-up after ETVa

    ImprovedSame as BaselineWorse Compared with BaselineP Value
    NICO Myriad UsedNo NICO MyriadNICO Myriad UsedNo NICO MyriadNICO Myriad UsedNo NICO Myriad
    Headache
        6 Mo88.9%80%11.1%13.3%0%6.7%>.05
        LFU77.8%53.3%22.2%33.3%0%13.3%>.05
    Dizziness
        6 Mo100%83.3%0%16.7%0%0%>.05
        LFU100%83.3%0%16.7%0%0%>.05
    Nausea
        6 Mo75%75%25%25%0%0%>.05
        LFU50%75%50%25%0%0%>.05
    Vision deficit
        6 Mo83.3%77.8%16.7%22.2%0%0%>.05
        LFU83.3%77.8%16.7%22.2%0%0%>.05
    Gait abnormality
        6 Mo100%100%0%0%0%0%>.05
        LFU100%70%0%10%0%20%>.05
    Urinary incontinence
        6 Mo100%100%0%0%0%0%>.05
        LFU85.7%85.7%0%0%14.3%14.3%>.05
    Cognitive dysfunction
        6 Mo87.5%70%12.5%30%0%0%>.05
        LFU87.5%70%12.5%20%0%10%>.05
    • Note:—LFU indicates last follow-up.

    • ↵a Outcomes are given among those with preoperative symptoms.

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American Journal of Neuroradiology: 39 (12)
American Journal of Neuroradiology
Vol. 39, Issue 12
1 Dec 2018
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M. Trelles, A.K. Ahmed, C.H. Mitchell, I. Josue-Torres, D. Rigamonti, A.M. Blitz
Natural History of Endoscopic Third Ventriculostomy in Adults: Serial Evaluation with High-Resolution CISS
American Journal of Neuroradiology Dec 2018, 39 (12) 2231-2236; DOI: 10.3174/ajnr.A5861

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Natural History of Endoscopic Third Ventriculostomy in Adults: Serial Evaluation with High-Resolution CISS
M. Trelles, A.K. Ahmed, C.H. Mitchell, I. Josue-Torres, D. Rigamonti, A.M. Blitz
American Journal of Neuroradiology Dec 2018, 39 (12) 2231-2236; DOI: 10.3174/ajnr.A5861
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