Assessing efficacy of endoscopic ventriculocisternostomy using a semi-rigid needle endoscope in сhildren with hydrocephalus and concomitant drug-resistant epilepsy: results of CT brain perfusion and time-frequency EEG analysis
https://doi.org/10.17749/2077-8333/epi.par.con.2021.105
Abstract
Background. The probability of seizures after endoscopic surgical treatment of hydrocephalus may comprise up to 9.5%, therefore accounting for a need to find solutions for alleviating the surgical trauma to the brain. One option to this problem might be based on using “seamless” neurosurgery, particularly endoscopes with a minimal outer sheath diameter (needle endoscopes, shunt endoscopes).
Objective: to evaluate major outcomes of surgically treated epilepsy, cerebral haemodynamics and electroencephalogram (EEG) in children with hydrocephalus and concomitant drug-resistant epilepsy before and after endoscopic ventriculocysternostomy of the third ventricular floor by using a semi-rigid needle endoscope.
Material and methods. In the early and remote postoperative periods, no epileptic seizures were observed in 57.1% of subjects (Engel Class I). Mean seizure frequency decreased from 12.9±6.1 to 0.82±0.31 per month (p<0.01). A significant decline in slow-wave amplitude and the paroxysmal index from 19.1±2.5% to 6.9±1.7% (p<0.01) were observed, as well as improvement of cerebral hemodynamics in the form of increased mean cerebral blood flow by 29.1±4.3% (p<0.01), mean circulating blood volume by 22.4±5.27% (p<0.05) and decreased mean transit time by 12.8±2.5% (p<0.05).
Results. In the early and remote postoperative periods, no epileptic seizures were observed in 57.1% of subjects (Engel Class I). Mean seizure frequency decreased from 12.9±6.1 to 0.82±0.31 per month (p<0.01). A significant decline in slow-wave amplitude and the paroxysmal index from 19.1±2.5% to 6.9±1.7% (p><0.01) were observed, as well as improvement of cerebral hemodynamics in the form of increased mean cerebral blood flow by 29.1±4.3% (p><0.01), mean circulating blood volume by ><0.01). A significant decline in slow-wave amplitude and the paroxysmal index from 19.1±2.5% to 6.9±1.7% (p<0.01), mean circulating blood volume by 22.4±5.27% (p<0.05) and decreased mean transit time by 12.8±2.5% (p><0.05).
About the Authors
A. A. SufianovRussian Federation
Albert А. Sufianov – Dr. Med. Sc., Professor, Chief of Chair of Neurosurgery, Sechenov University; Chief Physician, Federal Center of Neurosurgery
Scopus Author ID: 6603558501; RSCI SPIN-code: 1722-0448
8/2 Trubetskaya Str., Moscow 119991
5 4th km of Chervishevskiy Tract, Tyumen 625032
G. Z. Sufianova
Russian Federation
Galina Z. Sufianova – Dr. Med. Sc., Professor, Clinical Pharmacologist, Federal Center of Neurosurgery; Chief of Chair of Pharmacology, Tyumen State Medical University
WoS ResearcherID: C-4741-2017; RSCI SPIN-code: 3099-2780
5 4th km of Chervishevskiy Tract, Tyumen 625032
54 Odesskaya Str., Tyumen 625023
A. G. Shapkin
Russian Federation
Andrey G. Shapkin – MD, PhD, Neurosurgeon, Federal Center of Neurosurgery, Associate Professor, Chair of Pharmacology, Tyumen State Medical University
RSCI SPIN-code: 8656-9879
5 4th km of Chervishevskiy Tract, Tyumen 625032
54 Odesskaya Str., Tyumen 625023
I. S. Shelyagin
Russian Federation
Ivan S. Shelyagin – Neurosurgeon, Federal Center of Neurosurgery
RSCI SPIN-code: 4188-2029
5 4th km of Chervishevskiy Tract, Tyumen 625032
A. A. H. Al Zakhrani
Russian Federation
Abdurakhman A. Al Zakhrani – Postgraduate, Chair of Neurosurgery
8/2 Trubetskaya Str., Moscow 119991
R. R. Rustamov
Russian Federation
Rakhmonzhon R. Rustamov – Neurosurgeon, Federal Center of Neurosurgery
RSCI SPIN-code: 7311-9781
5 4th km of Chervishevskiy Tract, Tyumen 625032
S. Zh. Stefanov
Russian Federation
Stefan Zh. Stefanov – Deputy Chief Physician, Neurosurgeon
5 4th km of Chervishevskiy Tract, Tyumen 625032
A. M. Khayretdinov
Russian Federation
Aydar M. Khayretdinov – Functional Diagnostician
5 4th km of Chervishevskiy Tract, Tyumen 625032
R. A. Sufianov
Russian Federation
Rinat A. Sufianov – Assistant Professor, Chair of Neurosurgery
Scopus Author ID: 56001416700; RSCI SPIN-code: 1204-2994
8/2 Trubetskaya Str., Moscow 119991
K. Simfukwe
Russian Federation
Keith Simfukwe – Postgraduate, Chair of Neurosurgery
8/2 Trubetskaya Str., Moscow 119991
References
1. Kahle K.T., Kulkarni A.V., Limbrick D.D. Jr., Warf B.C. Hydrocephalus in children. Lancet. 2016; 387 (10020): 788–99. https://doi.org/10.1016/S0140-6736(15)60694-8.
2. Rizvi R., Anjum Q. Hydrocephalus in children. J Pak Med Assoc. 2005; 55 (11): 502–7.
3. Tully H.M., Dobyns W.B. Infantile hydrocephalus: a review of epidemiology, classification and causes. Eur J Med Genet. 2014; 57 (8): 359–68. https://doi.org/10.1016/j.ejmg.2014.06.002.
4. Keene D.L., Ventureyra E.C. Hydrocephalus and epileptic seizures. Childs Nerv Syst. 1999; 15 (4): 158–62. https://doi.org/10.1007/s003810050359.
5. Sato O., Yamguchi T., Kittaka M., Toyama H. Hydrocephalus and epilepsy. Childs Nerv Syst. 2001; 17 (1-2): 76–86. https://doi.org/10.1007/s003810000381.
6. Szefczyk-Polowczyk L., Mandera M. Functioning of the children with hydrocephalus. Acta Neurol Belg. 2020; 120 (2): 345–53. https://doi.org/10.1007/s13760-020-01280-y.
7. Tully H.M., Kukull W.A., Mueller B.A. Clinical and surgical factors associated with increased epilepsy risk in children with hydrocephalus. Pediatr Neurol. 2016; 59: 18–22. https://doi.org/10.1016/j.pediatrneurol.2016.02.011.
8. Yuan W., Holland S.K., Shimony J.S., et al. Abnormal structural connectivity in the brain networks of children with hydrocephalus. Neuroimage Clin. 2015; 8: 483–92. https://doi.org/10.1016/j.nicl.2015.04.015.
9. Pollay M. The function and structure of the cerebrospinal fluid outflow system. Cerebrospinal Fluid Res. 2010; 7: 9. https://doi.org/10.1186/1743-8454-7-9.
10. Reite M., Reite E., Collins D., et al. Brain size and brain/intracranial volume ratio in major mental illness. BMC Psychiatry. 2010; 10: 79. https://doi.org/10.1186/1471-244X-10-79.
11. Mukhin K.Iu., Kuz'mich G.V., Balkanskaia S.V., et al. Features of epileptiform activity on EEG in children with periventricular leukomalacya and cerebral palsy without epilepsy. The Korsakov's Journal of Neurology and Psychiatry. 2012; 112 (7-2): 71–6 (in Russ.).
12. Sufianov A.A., Sufianova G.Z., Iakimov I.A. Endoscopic third ventriculostomy in patients younger than 2 years: outcome analysis of 41 hydrocephalus cases. J Neurosurg Pediatr. 2010; 5 (4): 392–401. https://doi.org/10.3171/2009.11.PEDS09197.
13. Sufianov А.А., Shapkin А.G., Sufianova G.Z., et al. Application of local transformation fourier for estimation of EEG changes at patients with hydrocephaly after liquor-shunting and neuroendoscopic operations. The Russian Journal of Neurosurgery. 2010; 2: 47–51 (in Russ.).
14. Barkley A.S., Boop S., Barber J.K., et al. Post-operative seizure after first time endoscopic third ventriculostomy in pediatric patients. Childs Nerv Syst. 2021; 37 (6): 1871–5. https://doi.org/10.1007/s00381-021-05078-y.
15. Polat H., Aluçlu M.U., Özerdem M.S. Evaluation of potential auras in generalized epilepsy from EEG signals using deep convolutional neural networks and time-frequency representation. Biomed Tech (Berl). 2020; 65 (4): 379–91. https://doi.org/10.1515/bmt-2019-0098.
16. Mohamed M., Mediratta S., Chari A., et al. Post-haemorrhagic hydrocephalus is associated with poorer surgical and neurodevelopmental sequelae than other causes of infant hydrocephalus. Childs Nerv Syst. 2021; 37 (11): 3385–96. https://doi.org/10.1007/s00381-021-05226-4.
17. Punchak M., Mbabazi Kabachelor E., Ogwal M., et al. The incidence of postoperative seizures following treatment of postinfectious hydrocephalus in ugandan infants: a post hoc comparison of endoscopic treatment vs shunt placement in a randomized controlled trial. Neurosurgery. 2019; 85 (4): E714–21. https://doi.org/10.1093/neuros/nyz122.
18. Kato Y., Liew B.S., Sufianov A.A., et al. Review of global neurosurgery education: horizon of neurosurgery in the developing countries. Chin Neurosurg J. 2020; 6: 19. https://doi.org/10.1186/s41016-020-00194-1.
19. Sufianov A.A., Kasper E.M., Sufianov R.A. An optimized technique of endoscopic third ventriculocisternostomy (ETV) for children with occlusive hydrocephalus. Neurosurg Rev. 2018; 41 (3): 851–9. https://doi.org/10.1007/s10143-017-0934-9.
20. Gnezditskiy V.V. Inverse problem of EEG and clinical electroencephalography. Мoscow: MEDpress-inform; 2004: 648 pp. (in Russ.).
21. Engel J. Jr., Van Ness P.C., Rasmussen T.B., et al. Outcome with respect to epileptic seizures. In: Engel J. Jr. (Ed.) Surgical treatment of the epilepsies. New York: Raven; 1993: 609–21.
22. Sakharov V.L. Methods and means of analysis of medical and biological information. Taganrog: Izdatel’stvo TRTU; 2001: 70 pp. (in Russ.).
23. Symss N.P., Oi S. Theories of cerebrospinal fluid dynamics and hydrocephalus: historical trend. J Neurosurg Pediatr. 2013; 11 (2): 170–7. https://doi.org/10.3171/2012.3.PEDS0934.
Review
For citations:
Sufianov A.A., Sufianova G.Z., Shapkin A.G., Shelyagin I.S., Al Zakhrani A.A., Rustamov R.R., Stefanov S.Zh., Khayretdinov A.M., Sufianov R.A., Simfukwe K. Assessing efficacy of endoscopic ventriculocisternostomy using a semi-rigid needle endoscope in сhildren with hydrocephalus and concomitant drug-resistant epilepsy: results of CT brain perfusion and time-frequency EEG analysis. Epilepsy and paroxysmal conditions. 2021;13(4):349-358. (In Russ.) https://doi.org/10.17749/2077-8333/epi.par.con.2021.105

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.