Biomedical subjects

Sven Kienke

Publications and source records attributed to Sven Kienke.

4 recordsLinked to original sources

PubMed2005

Hydrocephalus in children with posterior fossa tumors: role of endoscopic third ventriculostomy.

OBJECT: Controversy exists regarding the indication for endoscopic third ventriculostomy (ETV) in children with hydrocephalus caused by posterior fossa tumors. The authors present their treatment modalities and discuss the role of ETV in the management of hydrocephalus. METHODS: The authors retrospectively reviewed the cases of 58 children who were admitted to their clinic consecutively with posterior fossa tumors between January 1999 and December 2003. Fifty-two patients presented with hydrocephalus. The mean age at the time of admission was 6 years and 3 months. The mean follow-up period was 25 months. The authors evaluated how many children required a cerebrospinal fluid (CSF) draining procedure (external ventricular drain [EVD], ventriculoperitoneal [VP] shunt, or ETV) prior to or following tumor removal. Only six patients (11.5%) required permanent treatment for hydrocephalus. Four patients received a VP shunt and two patients underwent ETV. A temporary EVD was placed in five patients (two required a shunt). Forty-six patients (88.5%) did not require a permanent CSF draining procedure. CONCLUSIONS: For children with posterior fossa tumors, ETV is not indicated as a standard operation either prior to or following tumor removal. Only six of 52 children presenting with hydrocephalus required a permanent CSF draining procedure. Endoscopic third ventriculostomy may be suitable for patients with fourth ventricle outflow obstruction and persisting or progressive hydrocephalus following tumor removal.

Adolescent↗

PubMed2005

Endoscopic third ventriculostomy in infants.

OBJECT: The failure rate following endoscopic third ventriculostomy (ETV) in infants younger than 1 year of age has been reported to be higher compared with that of older children. The authors present results of ETVs in such infants and advocate that success or failure of the procedure depends not on the age of the patient but on the cause of the hydrocephalus. METHODS: The authors retrospectively reviewed the management and outcome of 18 ETVs in infants for the treatment of hydrocephalus. The surgeries were performed between November 1996 and October 2002. The mean age at the time of surgery was 150 days (range 9-354 days). The minimal follow-up period was 18 months and the mean was 50 months. The authors divided the patients into the following three groups: obstructive hydrocephalus (four infants), communicating hydrocephalus (10 infants), and hydrocephalus associated with myelomeningocele (four infants). No perioperative death occurred, and perioperative transient morbidity related to ETV was low. The success of the procedure was determined by the cause of the hydrocephalus. Infants with obstructive hydrocephalus had a 100% success rate (four of four), and infants with communicating hydrocephalus had a 10% success rate (one of 10). In infants with hydrocephalus related to myelomeningocele, the success rate was 50% (two of four). CONCLUSIONS: The authors conclude that ETV presents an effective alternative for the treatment of obstructive hydrocephalus in infants younger than 1 year of age. Age does not present a contraindication for ETV, nor does it increase the perioperative risk. The success of ETV is determined by the cause of the hydrocephalus.

Age Factors↗

PubMed2004

Endoscopic aqueductoplasty and interventriculostomy for the treatment of isolated fourth ventricle in children.

OBJECTIVE: There are different approaches for the treatment of isolated fourth ventricle in children, including a suboccipital ventriculoperitoneal shunt, suboccipital craniotomy with microsurgical fenestration, and endoscopic fenestration. We discuss the indications, surgical methods, and outcome of 18 patients who underwent endoscopic treatment for isolated fourth ventricle. METHODS: We retrospectively reviewed the medical histories of 18 patients with an isolated fourth ventricle. Surgical procedures included endoscopic aqueductoplasty, endoscopic aqueductoplasty with a stent, endoscopic interventriculostomy (lateral ventricle or third ventricle to fourth ventricle), and endoscopic interventriculostomy with a stent. Operations were performed between July 1997 and June 2002. The mean age of the patients at the time of surgery was 3 years. The mean follow-up was 29 months. All patients had a supratentorial ventriculoperitoneal shunt. RESULTS: Clinical symptoms (impairment of consciousness, tetraparesis, and ataxia) improved in all patients. Reduction of the size of the fourth ventricle was observed in all patients. Seven patients required reoperation because of restenosis (39% revision rate). Restenosis occurred between 2 weeks and 7 months after surgery (average, 3 mo). Four patients underwent reoperation with stent placement, and three patients underwent reaqueductoplasty. We had the following complications: one infection, one asymptomatic subdural hygroma, one transient oculomotor paresis, and one permanent oculomotor paresis (4 [22%] of 18 patients). CONCLUSION: The significant failure rate of fourth ventricle shunts has led to the development of alternative treatment methods. Endoscopic aqueductoplasty or interventriculostomy presents an effective, minimally invasive, and safe procedure for the treatment of isolated fourth ventricle in pediatric patients. Compared with suboccipital craniotomy and microsurgical fenestration, endoscopic aqueductoplasty is less invasive, and compared with fourth ventricle shunts, it is more reliable and effective.

Adolescent↗

PubMed2003

Endoscopic aqueductoplasty: stent or not to stent?

OBJECTIVE: The aim of this study is to evaluate if the long-term interventricular communication following aqueductoplasty is determined by the etiology of the aqueductal stenosis (AS). METHODS: We retrospectively analyzed 27 patients who underwent endoscopic aqueductoplasty or endoscopic interventriculostomy with or without a stent for the treatment of AS or isolated fourth ventricle. Surgeries were performed between July 1997 and June 2003. Mean age at the time of surgery was 8 years. Mean follow-up is 24 months. RESULTS: We divided the patients into three groups. Group 1 consisted of 5 patients with membranous distal AS. Four patients were sufficiently treated by aqueductoplasty alone and 1 asymptomatic restenosis occurred. Group 2 consisted of 4 patients with AS due to a periaqueductal tumor. Three patients underwent aqueductoplasty and tumor biopsy with subsequent restenosis of the aqueduct. One patient underwent aqueductoplasty with a stent and tumor biopsy at the same time. Group 3 consisted of 18 patients with isolated fourth ventricle. The initial surgery was successful in 11 patients. Seven patients required revisions. CONCLUSION: The long-term communication following aqueductoplasty is determined by the etiology and morphology of the AS. In patients with a membranous distal AS aqueductoplasty alone will suffice. In patients with tumor-associated AS aqueductoplasty alone will not stay open. Those patients would better be treated with third ventriculostomy. In patients with isolated fourth ventricle the risk of restenosis is high. Therefore, we favor primary stent placement.

Adolescent↗