Endoscopic Third Ventriculostomy

Endoscopic third ventriculostomy (ETV) is a minimally invasive procedure commonly used to treat obstructive hydrocephalus. The objectives of the procedure are to fenestrate the floor of the third ventricle using a neuroendoscopic approach and to provide a cerebrospinal fluid (CSF) diversion. With high success rates published over the years, ETV became a routine modality for the obstructive hydrocephalus treatment. Furthermore, indications for ETV are expanding day by day and are no longer limited to obstructive hydrocephalus. Endoscopic third ventriculostomy has lower complication rate and has significant advantages compared to other CSF diversion techniques. Efficiency and safety of ETV are increasing with the advancements in technology

Is it more dangerous to perform inadequate packing?

Peri-hepatic packing procedure, which is the basic damage control technique for the treatment of hepatic hemorrhage, is one of the cornerstones of the surgical strategy for abdominal trauma. The purpose of this study was to evaluate the efficacy of the perihepatic packing procedure by comparing the outcomes of appropriately and inappropriately performed interventions. Trauma patients with liver injury were retrospectively evaluated. The patients who had undergone adequate packing were classified as Group A, and the patients who had undergone inappropriate packing, as Group B. Over a five-year period, nineteen patients underwent perihepatic packing. Thirteen of these patients were referred by other hospitals. Of 13 patients, 9 with inappropriate packing procedure due to insertion of intraabdominal drainage catheter (n=4) and underpacking (n=5) were evaluated in Group B, and the others (n=10) with adequate packing were assessed in Group A. Mean 3 units of blood were transfused in Group A and unpacking procedure was performed in the 24th hour. Only 3 (30%) patients required segment resection with homeostasis, and the mortality rate was 20% (2/10 patients). In Group B, 4 patients required repacking in the first 6 hrs. Mean 8 units of blood were transfused until unpacking procedure. The mortality rate was 44% (4/9 patients). The length of intensive care unit stay and requirement of blood transfusion were statistically significantly lower in Group A (p < 0.05). The mortality rate of this group was also lower. However, the difference between the groups for mortality rates was not statistically significant. This study emphasizes that efficacy of the procedure is one of the determinants that affects the results, and inadequate or inappropriate packing may easily result in poor outcome