Role of Endoscopic Third Ventriculostomy in Management of Malfunctioning Ventriculoperitoneal Shunt

Not Applicable

Not yet recruiting

• Conditions: Hydrocephalus; Shunt Malfunction
• Interventions: Device: Endoscopic third ventriculostomy

• Registration Number: NCT06341946
• Lead Sponsor: Sohag University

Brief Summary

The aim of this study is to analyze our experience in management of malfunctioning ventriculoperitoneal shunt by using endoscopic third ventriculostomy (ETV).

Detailed Description

Cerebrospinal fluid shunting remains the most common line of treatment for hydrocephalus. Endoscopic third ventriculostomy (ETV) is an alternative to cerebrospinal fluid (CSF) shunting that is potentially favorable due to the lack of implanted hardware. Most previous studies of ETV have focused on its role as an initial treatment for hydrocephalus and on comparing ETV with CSF shunting. However ,some patients who have previously been treated with a CSF shunt then developed malfunction are candidate for ETV.

The ETV Success Score (ETVSS) is the most widely used scale to estimate the likelihood of ETV success for a given patient .

Although the age of the patient is the most important component of the ETVSS, history of previous treatment with a shunt is also included in the model. According to the ETVSS, previous shunting reduces the likelihood of ETV success by approximately 10%.

There have been numerous previous studies of ETV in patients with a history of a CSF shunt (post shunt ETV), reporting success rates from 50% to 80% . Two review articles also covered this topic, one of which reported ETV success by meta-analysis in 68% of 519 pooled patients .

Most patients with shunt malfunction and or infection are treated with revision procedures, but ETV can be used as an alternative treatment in such cases .The role of endoscopic management of hydrocephalus in shunt malfunction was not investigated extensively so far.

There are several studies which have considered ETV as the main treatment of hydrocephalus inpatients with shunt failure.

Therefore, this is an attractive topic in neurosurgery especially in pediatric neurosurgery that can work and make a different kind of studies to explore the role of ETV for shunt failure.

The goal of the current study was to present our experience with endoscopic third ventriculostomy for management of shunt malfunction.

Study Timeline

• Status Verified: 2024-03
• Study First Submitted: 2024-03-07
• Study First Submitted QC: 2024-03-30
• Last Update Submitted: 2024-03-30
• Study First Posted: 2024-04-02
• Last Update Posted: 2024-04-02
• Study Start: 2024-04-05
• Primary Completion: 2025-10-01
• Study Completion: 2025-11

Recruitment & Eligibility

• Status: NOT_YET_RECRUITING
• Sex: All
• Target Recruitment: 30

Inclusion Criteria

• • All patients with malfunctioning VP shunt will be included in this study.

Exclusion Criteria

• Patients with contraindications for endoscopic procedure such as intracranial infection or bleeding disorders
• Previous unsuccessful attempts of endoscopic third ventriculostomy.
• Active infection or inflammation in the central nervous system.
• Recent history of intracranial hemorrhage.
• Medically unfit for surgery.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
endoscopic third ventriculostomy	Endoscopic third ventriculostomy	endoscopic third ventriculostomy in patients with malfunctioning ventriculoperitoneal shunt

Primary Outcome Measures

Name	Time	Method
visual acuity	base line	clinical symptoms improvement
Glasgow Coma Scale (GCS)	base line	clinical symptoms improvement this Score has values between 3 and 15, 3 being the worst and 15 being the highest
visual analogue scale( VAS )	base line	clinical symptoms improvement this Score has values between 0 and 10, 0 being the best and 10 being the worst

Secondary Outcome Measures

Name	Time	Method
radiological CT brain and or MRI brain	base line	CT brain and or MRI brain