Use of a simple intraoperative hydrostatic pressure test to assess the relationship between mobility of the ventricular stoma and success of third ventriculostomy.

Hdl Handle:
http://hdl.handle.net/10147/208879
Title:
Use of a simple intraoperative hydrostatic pressure test to assess the relationship between mobility of the ventricular stoma and success of third ventriculostomy.
Authors:
Kamel, Mahmoud Hamdy; Kelleher, Michael; Aquilina, Kristian; Lim, Chris; Caird, John; Kaar, George
Affiliation:
Neurosurgery Department, Cork University Hospital, Cork, Republic of Ireland., mahmoudhamdy@yahoo.com
Citation:
J Neurosurg. 2005 Nov;103(5):848-52.
Journal:
Journal of neurosurgery
Issue Date:
3-Feb-2012
URI:
http://hdl.handle.net/10147/208879
DOI:
10.3171/jns.2005.103.5.0848
PubMed ID:
16304989
Abstract:
OBJECT: Neuroendoscopists often note pulsatility or flabbiness of the floor of the third ventricle during endoscopic third ventriculostomy (ETV) and believe that either is a good indication of the procedure's success. Note, however, that this belief has never been objectively measured or proven in a prospective study. The authors report on a simple test-the hydrostatic test-to assess the mobility of the floor of the third ventricle and confirm adequate ventricular flow. They also analyzed the relationship between a mobile floor (a positive hydrostatic test) and prospective success of ETV. METHODS: During a period of 3 years between July 2001 and July 2004, 30 ETVs for obstructive hydrocephalus were performed in 22 male and eight female patients. Once the stoma had been created, the irrigating Ringer lactate solution was set at a 30-cm height from the external auditory meatus, and the irrigation valve was opened while the other ports on the endoscope were closed. The ventricular floor ballooned downward and stabilized. The irrigation valve was then closed and ports of the endoscope were opened. The magnitude of the upward displacement of the floor was then assessed. Funneling of the stoma was deemed to be a good indicator of floor mobility, adequate flow, and a positive hydrostatic test. All endoscopic procedures were recorded using digital video and recordings were subsequently assessed separately by two blinded experienced neuroendoscopists. Patients underwent prospective clinical follow up during a mean period of 11.2 months (range 1 month-3 years), computerized tomography and/or magnetic resonance imaging studies of the brain, and measurements of cerebrospinal fluid pressure through a ventricular reservoir when present. Failure of ETV was defined as the subsequent need for shunt implantation. The overall success rate of the ETV was 70% and varied from 86.9% in patients with a mobile stoma and a positive hydrostatic test to only 14.2% in patients with a poorly mobile floor and a negative test (p < 0.05). The positive predictive value of the hydrostatic test was 86.9%, negative predictive value 85.7%, sensitivity 95.2%, and specificity 66.6%. CONCLUSIONS: The authors concluded that the hydrostatic test is an easy, brief test. A positive test result confirms a mobile ventricular floor and adequate flow through the created ventriculostomy. Mobility of the stoma is an important predictor of ETV success provided that there is no obstruction at the level of the arachnoid granulations or venous outflow. A thin, redundant, mobile third ventricle floor indicates a longstanding pressure differential between the third ventricle and the basal cisterns, which is a crucial factor for ETV success. A positive hydrostatic test may avert the need to insert a ventricular reservoir, thus avoiding associated risks of infection.
Language:
eng
MeSH:
Adolescent; Adult; Aged; Cerebrospinal Fluid/metabolism; Child; Endoscopy; Female; Humans; Hydrocephalus/*diagnosis/*surgery; Hydrostatic Pressure; Infant; Infant, Newborn; Male; Middle Aged; Monitoring, Intraoperative/*methods; Predictive Value of Tests; Prognosis; Prospective Studies; Third Ventricle/*surgery; *Ventriculostomy
ISSN:
0022-3085 (Print); 0022-3085 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorKamel, Mahmoud Hamdyen_GB
dc.contributor.authorKelleher, Michaelen_GB
dc.contributor.authorAquilina, Kristianen_GB
dc.contributor.authorLim, Chrisen_GB
dc.contributor.authorCaird, Johnen_GB
dc.contributor.authorKaar, Georgeen_GB
dc.date.accessioned2012-02-03T15:06:17Z-
dc.date.available2012-02-03T15:06:17Z-
dc.date.issued2012-02-03T15:06:17Z-
dc.identifier.citationJ Neurosurg. 2005 Nov;103(5):848-52.en_GB
dc.identifier.issn0022-3085 (Print)en_GB
dc.identifier.issn0022-3085 (Linking)en_GB
dc.identifier.pmid16304989en_GB
dc.identifier.doi10.3171/jns.2005.103.5.0848en_GB
dc.identifier.urihttp://hdl.handle.net/10147/208879-
dc.description.abstractOBJECT: Neuroendoscopists often note pulsatility or flabbiness of the floor of the third ventricle during endoscopic third ventriculostomy (ETV) and believe that either is a good indication of the procedure's success. Note, however, that this belief has never been objectively measured or proven in a prospective study. The authors report on a simple test-the hydrostatic test-to assess the mobility of the floor of the third ventricle and confirm adequate ventricular flow. They also analyzed the relationship between a mobile floor (a positive hydrostatic test) and prospective success of ETV. METHODS: During a period of 3 years between July 2001 and July 2004, 30 ETVs for obstructive hydrocephalus were performed in 22 male and eight female patients. Once the stoma had been created, the irrigating Ringer lactate solution was set at a 30-cm height from the external auditory meatus, and the irrigation valve was opened while the other ports on the endoscope were closed. The ventricular floor ballooned downward and stabilized. The irrigation valve was then closed and ports of the endoscope were opened. The magnitude of the upward displacement of the floor was then assessed. Funneling of the stoma was deemed to be a good indicator of floor mobility, adequate flow, and a positive hydrostatic test. All endoscopic procedures were recorded using digital video and recordings were subsequently assessed separately by two blinded experienced neuroendoscopists. Patients underwent prospective clinical follow up during a mean period of 11.2 months (range 1 month-3 years), computerized tomography and/or magnetic resonance imaging studies of the brain, and measurements of cerebrospinal fluid pressure through a ventricular reservoir when present. Failure of ETV was defined as the subsequent need for shunt implantation. The overall success rate of the ETV was 70% and varied from 86.9% in patients with a mobile stoma and a positive hydrostatic test to only 14.2% in patients with a poorly mobile floor and a negative test (p < 0.05). The positive predictive value of the hydrostatic test was 86.9%, negative predictive value 85.7%, sensitivity 95.2%, and specificity 66.6%. CONCLUSIONS: The authors concluded that the hydrostatic test is an easy, brief test. A positive test result confirms a mobile ventricular floor and adequate flow through the created ventriculostomy. Mobility of the stoma is an important predictor of ETV success provided that there is no obstruction at the level of the arachnoid granulations or venous outflow. A thin, redundant, mobile third ventricle floor indicates a longstanding pressure differential between the third ventricle and the basal cisterns, which is a crucial factor for ETV success. A positive hydrostatic test may avert the need to insert a ventricular reservoir, thus avoiding associated risks of infection.en_GB
dc.language.isoengen_GB
dc.subject.meshAdolescenten_GB
dc.subject.meshAdulten_GB
dc.subject.meshAgeden_GB
dc.subject.meshCerebrospinal Fluid/metabolismen_GB
dc.subject.meshChilden_GB
dc.subject.meshEndoscopyen_GB
dc.subject.meshFemaleen_GB
dc.subject.meshHumansen_GB
dc.subject.meshHydrocephalus/*diagnosis/*surgeryen_GB
dc.subject.meshHydrostatic Pressureen_GB
dc.subject.meshInfanten_GB
dc.subject.meshInfant, Newbornen_GB
dc.subject.meshMaleen_GB
dc.subject.meshMiddle Ageden_GB
dc.subject.meshMonitoring, Intraoperative/*methodsen_GB
dc.subject.meshPredictive Value of Testsen_GB
dc.subject.meshPrognosisen_GB
dc.subject.meshProspective Studiesen_GB
dc.subject.meshThird Ventricle/*surgeryen_GB
dc.subject.mesh*Ventriculostomyen_GB
dc.titleUse of a simple intraoperative hydrostatic pressure test to assess the relationship between mobility of the ventricular stoma and success of third ventriculostomy.en_GB
dc.contributor.departmentNeurosurgery Department, Cork University Hospital, Cork, Republic of Ireland., mahmoudhamdy@yahoo.comen_GB
dc.identifier.journalJournal of neurosurgeryen_GB
dc.description.provinceMunster-

Related articles on PubMed

All Items in Lenus, The Irish Health Repository are protected by copyright, with all rights reserved, unless otherwise indicated.