Endovascular balloon usage in endoscopic third ventriculostomy for hydrocephalus during a national shortage: case series and technical note

TL;DR

This paper discusses using alternative balloons during brain surgery for hydrocephalus when the usual device is unavailable.

Contribution

The study demonstrates the viability of using cardiac and neurovascular balloons as alternatives to the Neuroballoon in endoscopic third ventriculostomy.

Findings

The Scepter balloon was effective but presented technical challenges due to its pliability.

The Cardiac TREK balloon was both effective and easier to manage endoscopically at a lower cost.

Non-neuroendoscopic balloons can be used successfully for ETV dilation during Neuroballoon shortages.

Abstract

Endoscopic third ventriculostomy (ETV) is a well-established surgical technique for treating hydrocephalus. Many providers have transitioned to utilizing the specialized Neuroballoon for the stoma dilation in ETV; however, these devices are intermittently unavailable during supply chain shortages. We present the experience of employing cardiac angioplasty and neurovascular balloons as substitutes for the Neuroballoon in 3 patients. The scepter balloon (Microvention), priced at $1800 compared to the standard $300 Neuroballoon (Integra), proved effective, but its pliability presented technical challenges. The substantial cost differential compared to a Neuroballoon ($300) raises economic considerations. The Cardiac TREK balloon (Abbott) was similarly effective, while also being easier to manage endoscopically and cheaper at $158. These experiences support the viability of non-neuroendoscopic specialized balloons as alternatives for ETV dilation of the floor of tuber cinereum.

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