AUCTORES
Globalize your Research
Research Article | DOI: https://doi.org/10.31579/2578-8868/274
Department of Neurosurgery, Fayoum University Hospitals, Fayoum University, Fayoum, Egypt.
*Corresponding Author: Ahmed Hosameldin, Department of Neurosurgery, Fayoum University Hospitals, Fayoum University, Fayoum, Egypt.
Citation: Ahmed Hosameldin, (2023), Endoscopic Third Ventriculostomy for Obstructive Hydrocephalus in Children; Challenges and Clinical Outcomes, J. Neuroscience and Neurological Surgery, 13(3); DOI:10.31579/2578-8868/274
Copyright: © 2023, Ahmed Hosameldin, This is an open-access article distributed under the terms of The Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
Received: 10 February 2023 | Accepted: 24 April 2023 | Published: 28 April 2023
Keywords: endoscopic third ventriculostomy; cerebrospinal fluid; vp shunt; obstructive hydrocephalus
Background: Endoscopic third ventriculostomy (ETV) has been established as a viable treatment option for obstructive hydrocephalus of children over 8 weeks of age. ETV in pediatric groups may be unsuccessful due to the failure of redirection of cerebrospinal fluid (CSF) flow, re-closure of ventriculostomy opening or due to infection. The exact cause is still debatable. Some issues like failure to eliminate the second membrane during the procedure or formation of the new arachnoid membrane at the stoma are still not clear. This study aims to assess the surgical failure of ETV and its predisposing factors.Methods: Thirty-two pediatric patients with hydrocephalus were analyzed retrospectively to assess efficacy of endoscopic third ventriculostomy in children. The patients’ age limit was between 6 months and 12 years. This is a retrospective study of 32 patients in Fayoum University Hospital in the period between May 2017 and December 2020. Patients having hydrocephalus in pediatric groups more than 8 weeks of age were included in the study.Results: The mean age of all patients was 24 months and the mean follow-up period was six months. Of 32 ETVs, the success rate was 78% in 25 patients and the failure rate was 22% in 7 patients. The study included 24 males (75 %) and 8 females (25%) with a male to female ratio (3:1). Clinical presentations varied from enlarged head (macrocrania), dilated scalp veins, repeated vomiting and poor ocular fixation and following. Complications were divided into failure of procedure, infection, CSF leak and re-exploration.Conclusions: Endoscopic ventriculocisternostomy remains an effective surgical technique in the treatment of obstructive hydrocephalus. It is linked to a very low rate of permanent morbidity and avoids ventriculo- peritoneal shunt-related morbidity and long life shunt dependence. But we should take in consideration good selection of indicated cases especially in pediatric groub.
Non communicating hydrocephalus either congenital, secondary to infection, hemorrhage or an obstructive lesion [3,11,21]. This pathology, which is frequent in the pediatric environment, recognizes a multitude of etiologies, most often malformative and haemorrhagic in the neonatal period, post-meningitis in infants and tumours in older children [24,25,27]. For a long time, cerebrospinal fluid (CSF) bypass shunts were the only treatment for hydrocephalus. The development of neuro-endoscopy has brought other possibilities in the treatment of this pathology. Endoscopic third ventriculostomy (ETV) is now considered a vital treatment option for obstructive hydrocephalus. ETV has been established for many children with hydrocephalus as an effective treatment [16]. This lack of data collected for efficacy of ETV in children limits our ability to answer questions regarding ETV complications and efficacy. Precise data on intraoperative events are especially lacking, and the effect these events can have on ETV performance. While the ETV Performance Score (ETVSS) has helped surgeons predict the performance of the operation based on preoperative factors, identifying significant intraoperative factors can further assist decision-making surgeons and perhaps provide insight into the critical technical elements of an optimal ETV [9,13,18,20]. The diagnosis of shunt malfunction was made based on clinical symptoms and radiologic signs, including ventricular dilatation on CT. Some CT scans showed only slight differences in ventricular dimensions compared with previous radiologic studies performed when the shunts were functioning, reflecting the loss of ependymal elasticity and brain compliance in these patients after a long-term shunt [5,6]
Data were collected from children who underwent ETV for obstructive hydrocephalus in pediatric groups from 6 months to 12 years between May 2017 and December 2020. This is a retrospective study of 32 patients. Most patients had undergone recent magnetic resonance imaging (MRI) of the brain for routine ETV in hydrocephalus patients. In emergency cases, a CT scan of the brain was done. Before doing re-exploration for ETV, MRI was considered in symptomatic patients. The selection criteria of patients for ETV were based on clinical symptoms and signs and the CT scan of the brain or MRI of the brain in pediatric hydrocephalus groupwho were more than 6 weeks old. The parameters studied included clinical (tri ventricular dilatation, tetra ventricular dilatation); etiological (congenital, infectious, tumor); endoscopic findings (hemosiderin deposits, choroid plexus atrophy or hyperplasia, pulsation of the 3rd ventricle floor, arachnoid adhesions, hypothalamic adhesions, closure of the aqueduct of Sylvius, narrow retroclival space, venous bleeding).
Outcome assessment
Clinical outcomes were assessed using neurological examination and Glasgow Coma Scale (GCS). Also CSF leak was assessed daily till removal of stitches. Day after day sterile dressing is recommended to avoid infection. While radiological assessment was through serial CT scans on 1st day, one week and one month postoperative. In some cases MRI postoperative was required with CSF flowmetry study to assess the difference in dynamics of CSF flow. All patients were followed up monthly for six months period in outpatient clinic. All statistical analyses were performed using SPSS software version 21. The p value < 0>
Surgical Technique
All procedures with patients under general anesthesia and in a supine positionhave been performed, and the little LOTTA system of KARL STORZ was used for all cases which are autoclave compatible. After a linear incision (2–3 cm) of the skin, an approach was made via a Kocher frontal burr hole (1–2 cm in front of the coronal suture and 2.5 cm lateral to the midline) to ensure an adequate trajectory. Foramen of monro was identified and the endoscope was advanced to the third ventricle. (Figure 1)
Figure 1: Endoscopic view of Foramen of Monro
The pre-mesencephalic cistern was inspected and in between infundibular recess and mammillary bodies in the midline a fenestration was made through the monopolar electrode and was enlarged further via Fogarty balloon catheter for sufficient CSF flow. The endoscope was advanced to the stoma for inspection of the basilar artery and its branches and also to look for the other membranes in the pre-pontine space. (Figure 2) (Figure 3)
Figure 2: Endoscopic view through ventriculostomy stoma showing Basilar artery and its branches
The present study included a total of 32 patients. Among them, 24 (75%) were male and 8 (25%) were female patients. We included patients between 6 months to 12 years in our study. The mean age of all patients was 32.25 ± 35.90 months (range 6–144 months). The age range from 6 to 36 months was the most affected (84.4%) with a male predominance (sex ratio of 3:1). Table 1.
| Variable | Number (%) |
| Sex | |
| Males | 24 (75%) |
| Females | 8 (25%) |
| Age | |
| 8 to 36 months | 27 (84.4%) |
| 36 months and above | 5 (16.6%) |
Table 1: Sex and age in our study
Etiology varied through patients, twenty-six patients (81.25%) had congenital anomaly or malformation of ventricular system mostly aqueduct of Sylvius stenosis , four patients (12.5%) infectious, two patients (6.25%) tumoral. Table 2.
| Etiology | Number (%) |
| Congenital | 26 (81.25%) |
| 6 to 36 months | 4 (12.5%%) |
| 36 months and above | 2 (6.25%%) |
Table 2: Etiology variations
Clinical manifestations varied from enlarged head, bulging anterior fontanelle, repeated vomiting, poor suckling, poor crying, seizures, dilated scalp veins and visual disturbance especially poor fixation or following in infants. Table 3.
| Clinical manifestations | Number (%) |
| Enlarged head | 32 (100%) |
| Bulging anterior fontanelle | 28 (87.5%%) |
| Repeated vomiting | 20 (62.5%%) |
| Poor suckling | 12 (37.5%) |
| Poor crying | 8 (25%) |
| Seizures | 12 (37.5%) |
| Dilated scalp veins | 4 (12.5%) |
| Visual disturbance | 6 (18.75%) |
| Sunset appearance | 2 (6.25%) |
| Delayed developmental milestones | 20 (62.5%%) |
Table 3: Clinical manifestations
Neuroimaging characteristic of obstructive hydrocephalus, represented by the ventricular dilatations. The average duration of the procedure was 40 minutes. In our study, there were no intraoperative complications of endoscopic procedures. The endoscopic finding revealed in almost all patient aqueductal stenosis, a choroid plexus hyperplasia in 4 patients (12.5%) for whom choroid plexus coagulation was done, multiple thin thread like membranes in 4 patients (12.5%) which denoted signs of infection, 2 patients (6.25%) showed hemosiderin deposits indicating hemorrhagic course and narrow retroclival space were observed in 16 patients (50%). In this series, all patients were followed for at least 6 months. During follow-up, patients were examined regularly at outpatient clinic to assess the head size, developmental milestones like neck holding, sitting, and walking were evaluated along with psychomotor assessment. Two patients (6.25%) revealed a delay in developmental milestones. A postoperative CT scan of the brain was performed postoperative at 1st day, one week, one month and six months routinely. Any patient who had increased size of the head, tense anterior fontanelle, or any sign of raised intracranial pressure with evidence of increased ventricular size in CT was advised for MRI of the brain. Post-operatively, there were twenty six patients (81.25%) without complications, while six other patients (18.75%) had complications in the form of CSF leak in 4 patients (12.5%), superficial wound infection in 2 patients (6.25%), failure of procedure and re-exploration with shunt insertion in one patient (3.1%).
Obstructive hydrocephalus is a difficult challenge to many neurosurgeons for precise decision making and several studies have examined the different treatment options and their effectiveness [14,19,29]. ETV has rising reputation in the treatment of obstructive hydrocephalus rather than traditional ventriculo-peritoneal shunting procedures in selected patients. ETV has been used for children with obstructive hydrocephalus as an effective measure of treatment. Some authors in literature documented predisposing factors to failure of ETV especially in pediatric group. Although there is lack of data considering its efficacy and complication rates. In our study, we discuss causes and challenges of pre-operative decision making to identify factors predictive of ETV dysfunction in cases of obstructive hydrocephalus in children. We conducted a study on 32 children with obstructive hydrocephalus in which precise decision was made to perform an ETV to divert CSF flow through a newly formed stoma to overwhelm the obstructive pathology. In or study, we found a male predominance of (75%) with a sex ratio (M/F) of 3:1. Several studies have shown a predominance of males and this predominance could be linked to the fact that congenital hydrocephalus can be transmitted in a sex-linked recessive mode [19,29]. The age of the children ranged from 6 months to 144 months (12 years) with a mean of 32.25 ± 35.90 months. The age range from 8 to 36 months was the most affected (75%). Ignorance and lack of knowledge of parents may result in delay of seeking medical consultation. According to clinical signs progressive macrocephaly followed by bulging anterior fontanelle and dilated scalp veins respectively. As regards to age, the incidence of ETV dysfunction is higher in infants than in children [3]. According to Kadrian et al., there is a strong effect of patient age on outcome [1]. Drake and colleagues concluded that the success rate of ETV essentially depends on patients age. [7]. A recent study observed that younger patients with preterm birth had a lower success rate comparing those patients who were mature at the birth time [17]. According to Heshmati, ETV’s success rate was around 60% which is lower than the recorded rates in pediatric populations [15]. In our study, we got a 75% ETV success rate in all patients. Within two years, the success rate was 60% while above two years success rate was 90%. Feng et al. found that ETV successfully treated obstructive hydrocephalus in 75% of patients [10]. Duru et al. documented their experience with ETV in 51 children under the age of 16; they reported an overall success rate of 80% for all etiologies and ages [8]. According to the report of Sodhia et al., the success of ETV in children aged 1–2 years also amounted to 80% [23]. Salvador S. F. et al. found in 2014 that age is a predictive factor of endoscopic ventriculo-cisternostomy dysfunction [22]. The etiological diagnosis of hydrocephalus was based on patient history, clinical findings, and CT brain. In our study, congenital hydrocephalus due to aqueductal stenosis was the most common cause and consanguineous marriage could be charged for such predominance. Other causes were addressed such as infection, hemorrhage and tumors. Vaessen S. et Coll in Liege in 2006 reported in their study of hydrocephalus in children that malformations were the most frequent cause followed by idiopathic malformations with proportions of 35% and 15% respectively [28]. In a study, the univariate and multivariate analysis showed that both hydrocephalus etiology and patient age were relevant factors predicting ETV success [12]. The complication rate is widely recognized as being linked to the surgeon’s experience. In our study, Leakage of CSF through the incision was reported in 6 cases and only one case of wound infection that was managed with antibiotics and repeated dressings. Failure of ETV was encountered in 8 patients (25%) in our series. Those patients were re explored endoscopically to assess the cause of failure and we found that stoma closure was encountered in two patients, newly formed arachnoid membranes either pre-mesencephalic or over ventriculostomy was encountered in three patients, blood clot was also in charge of 3rd ventricular floor obstruction in one case and finally two cases with no obvious cause of failure. Bouras T. et al. in his meta- analysis claimed that CSF leakage through the operative wound is the most frequent postoperative complication found in the literature; according to, the incidence of this complication varies between 0-5.2% with an average of 1.7% [4]. We believe that thin skin and immature subarachnoid spaces in pediatrics could be related to this result. Baldauf J. et al. mentioned that the existence of arachnoid adhesions in patients shows a higher proportion of ETV failure compared to the absence of this abnormality [3]. The output of an ETV presents possible risks like CSF leakage, infection, subdural hygromas, and hematomas. ETV has rescued the hydrocephalic patient from shunt dependency and its complications as a foreign body [15]. Yadav et al. mentioned that pre-operative identification of the exact etiology of hydrocephalus can increase the success rate of the ETV and avoid unnecessary surgery [30]. So we agree that the correct selection of patients is essential for achieving good results with ETV. Previous shunting operation and complex hydrocephalus were reported to be the main causes of ETV failure [12]. So, we can delineate predisposing factors that cause ETV failure are ventriculostomy stoma closure by new arachnoid granulation tissues, second membrane formation within the stoma or pre- mesencephalic, CSF absorption failure, CSF infection/high protein, and improper selection of patients. The mechanism of failure usually in other studies is the closure of the stoma due to local inflammatory reaction, and its incidence is also related to the underlying pathology.
The endoscopic third ventriculostomy, in general, remains an effective surgical technique in the treatment of obstructive hydrocephalus and could be very effective method with precisely selected pediatric age group. It has the upper hand as it avoids ventriculo-peritoneal shunt-related morbidity or being lifelong shunt dependent. Factors causing ETV failure are ventriculostomy stoma closure by new arachnoid membranes, remnant or newly formed pre-mesencephalic membranes, infection or high protein content.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
