Endoscopic Third Ventriculostomy in Idiopathic Normal Pressure Hydrocephalus

Abstract

In patients with INPH showing short duration of symptoms, prevalence of gait disturbance, and slight mental impairment, ETV provides similar results to those of shunting. We suggest performing ETV in these patients and reserving shunting only for those who do not improve after ETV, despite the presence of cerebrospinal fluid flow through the ventriculostomy on MRI flow studies. The good results after ETV in our series indirectly confirm that the cerebrospinal fluid absorption is good or at least sufficient in selected patients with INPH.

Complications of Endoscopic Third Ventriculostomy

“…Reported rates of intraoperative bleeding vary from 0 to 8.5% (1,2,4,7,13,27). A generally accepted rate of considerable hemorrhagic incidents during ETV is 4%.…”

Endoscopic third ventriculostomy

“…27 Slit ventricle syndrome can be treated with third ventriculostomy, 62,63 as well as normal pressure hydrocephalus; in particular, gait disturbance was improved in this patient cohort. 17,64 The effectiveness of third ventriculostomy in treating hydrocephalus in the setting of spinal dysraphism has been shown by some. 36 In one case involving a Chiari malformation with hydrocephalus and cervical syringomyelia, the procedure helped treat the hydrocephalus and syrinx.…”

“…They include open craniotomy via subfrontal and subtemporal approaches as well as percutaneous, including ventriculoscopic, free-hand, or stereotactic techniques. 5,[14][15][16][17][18][19][20][21][22] The failure rate of third ventriculostomy varies substantially based upon patient cohorts.…”

Success criteria in pediatric neuroendoscopic procedures. Proposal for classification of results after 67 operations

“…Rationale also exists for ETV in communicating hydrocephalus [3,4] based on the hydrodynamic concept of hydrocephalus [5]. Nevertheless, controversial issues surround the real impact of the procedure on the overall hydrocephalic population, and on the criteria for patient selection and long-term success [6,7].…”