Effect of endoscopic third ventriculostomy on neuropsychological outcome in late onset idiopathic aqueduct stenosis: a prospective study

Abstract

Objective: To undertake a prospective study of the long term neuropsychological outcome in patients with late onset idiopathic aqueduct stenosis (LIAS) after endoscopic third ventriculostomy. Methods: Six patients with LIAS were evaluated pre-and postoperatively using magnetic resonance imaging (MRI) and standardised psychometric testing procedures. Endoscopic third ventriculostomy was done using standard surgical techniques. The mean long term follow up was 81.2 weeks. Results: Preoperatively, all patients had cognitive impairment, four of them showing deficits in several cognitive domains. After endoscopic third ventriculostomy, all patients improved clinically and had ventricular size reduction on MRI. Postoperative neuropsychological testing showed that five patients achieved normal or near normal cognitive functions, and one improved moderately. Conclusions: Endoscopic third ventriculostomy caused a substantial improvement in the neuropsychological deficit of LIAS patients. This was also true for patients with enlarged ventricles that might be diagnosed radiologically as "arrested hydrocephalus."

Endoscopic Third Ventriculostomy for Idiopathic Aqueductal Stenosis

“…Burtscher et al (7) in a prospective study evaluated 6 patients affected by late-onset aqueductal stenosis using standardized psychometric testing preoperatively and postoperatively. They found improvement of preoperative deficits (usually combined deficits of memory and frontal-executive function) in all patients (full recovery in 2, good recovery in 3, and moderate recovery in 1 (65) reviewed long-term outcomes and neurological development in children affected by obstructive hydrocephalus, treated with ETV when they were younger than 9 months.…”

Gravitational Shunts in Longstanding Overt Ventriculomegaly in Adults

“…ETV is a valuable modern alternative to shunt implantation (4,7,8,10,12,19,43,47). That ETV does not involve implantation of foreign material is surely a point in its favor.…”

Neuropsychological Assessment of Adult Patients with Shunted Hydrocephalus

“…Another study demonstrated that endoscopic third ventriculostomy substantially improves the neuropsychological deficit in the late onset idiopathic aqueduct stenosis. These patients achieved normal or near normal cognitive function 4) . However, there has been still no report about comparison of neurocognitive function of hydrocephalic patients whose diseases are related with different aetiologies.…”

“…So, we also agree with these authors that more studies are required to resolve the pathophysiology and management of the hydrocephalus. On the other hand Burtscher et al (2001) showed that the deficit pattern of the patients with late onset idiopathic aqueduct stenosis (LIAS) was similar to that found in other hydrocephalic disorders, but was very dissimilar to hydrocephalic dementia known as "normal pressure hydrocephalus" in older patients; and they declared that third ventriculostomy improved the neuropsychological function near to normal in five of six patients with LIAS 4) . Therefore, we think that the effectiveness of the shunt surgery and third ventriculostomy on the neurocognitive function of the hydrocephalic patients should be evaluated and also compared in future studies.…”