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العنوان
Ventriculoperitoneal Shunt versus Endoscopic Third Ventriculostomy in the treatment of Obstructive Hydrocephalus in Pediatric Midline Posterior Fossa tumors :
المؤلف
Eldeif, Mohammed Tarek Elsayed.
هيئة الاعداد
باحث / محمد طارق السيد الضيف
مشرف / حمدي ابراهيم خليل
مشرف / حسن محمد جلال الدين
مشرف / سامح رشدي اسكندر
تاريخ النشر
2020.
عدد الصفحات
219 p. :
اللغة
الإنجليزية
الدرجة
ماجستير
التخصص
علم الأعصاب السريري
تاريخ الإجازة
1/1/2020
مكان الإجازة
جامعة عين شمس - كلية الطب - جراحة المخ و الاعصاب والعمود الفقرى
الفهرس
Only 14 pages are availabe for public view

from 218

from 218

Abstract

Treatment of 2ry hydrocephalus due to posterior fossa tumors in these children is still a matter of controversy, although preoperative ventriculo-peritoneal shunt(VP shunt) insertion before tumor excision is widely accepted among neurosurgeons but many attempts are rising to minimize permanent VP shunt insertion and associated complications and introducing endoscopic third ventriculostomy (ETV) as one of the options of 2ry hydrocephalus.
In our systematic review we were comparing the post-operative clinical success with resolution of the manifestations and post-operative complications between endoscopic third ventriculostomy and ventriculo-peritoneal shunt as different modes of CSF diversion in children with 2ry hydrocephalus due to midline posterior fossa tumors.
The following electronic databases are searched from June 2009 to June 2019: PubMed, Google scholar search engine. Cochrane database of systematic reviews, EMBASE and science Direct, using the keywords “hydrocephalus; posterior fossa tumors; pediatrics; ventriculoperitoneal shunt; endoscopic third ventriculostomy”. Studies will be eligible if they contain the target keywords in title or abstract, addressing the Pediatric age group with 2ry hydrocephalus due to de novo posterior fossa tumor manifested by signs of increase the intra cranial tension including persistent headache and vomiting, blurred vision, 6th nerve palsy, papilledema in fundus examination, acute DCL and 2ry hydrocephalus confirmed by brain imaging. Exclusion criteria included studies including age group below 1yr or above 18 yr, or patients with recurrent post fossa tumors and operated before or patients presented by failed previously attempt of CSF diversion.
A total of 1255 citations were screened for eligibility,6 studies were included in our systematic review discussing, comparing and evaluating the durability of ETV versus VP shunt in treatment the 2ry hydrocephalusdue to pediatric posterior fossa tumor. Overall study population reached 474 patients. the overall clinical findings at presentation and post operative outcomes regarding the clinical findings improvement, radiological improvement and post operative complications between ETV and VPshunt are compared and showing that ETV should be considered as an alternative procedure to VP shunt in controlling severe hydrocephalus related to posterior fossa tumors to relieve symptoms quickly during the preoperative period when patients should wait for their definite tumor excision.
We found that the shorter duration of surgery, the lower incidence of morbidity, the absence of mortality, the lower incidence of procedure failure of endoscopic third ventriculostomy as compared to ventriculoperitoneal shunt, and the significant advantage of not becoming shunt dependent make endoscopic third ventriculostomy to be recommended as the first choice in the treatment of pediatric patients with marked obstructive hydrocephalus due to posterior fossa tumors. It is a preliminary, simple, safe, effective, physiological, minimally invasive procedure for the relief of elevated intracranial pressure before direct tumor removal.