Endoscopic third ventriculostomy in treatment of hydrocephalus.

Abstract

IntroductionEndoscopic third ventriculostomy (ETV) is a minimally invasive method of treatment of obstructive hydrocephalus (HCP).AimTo investigate perioperative and intraoperative difficulties, failures and complications of ETV.Material and methodsSeventy-three procedures of ETV were conducted in our department in the last 5 years on 69 patients with HCP of different etiology. In 4 patients we performed ETV twice. In 4 cases we used neuronavigation. In 6 cases ETV was performed in conjunction with endoscopic biopsy of the tumor. In 6 cases we had to repeat the procedure (4) or implant a ventriculo-peritoneal shunt (2) due to recurrence of symptoms.ResultsIn our series we had 3 important complications: one thalamic injury and 2 intraventricular hemorrhages. In 4 cases we observed postoperative hyperthermia with the presence of meningeal symptoms. Two cerebrospinal fluid (CSF) leaks were secured with additional stitches and 2 CSF infections were treated with antibiotics. In 1 patient epileptic seizers were observed. Three others complained of nausea and vomiting. The initial success rate of ETV is 70%.ConclusionsBased on our material we conclude that ETV is a useful and helpful procedure in non-communicating HCP. It carries 4% perioperative risk of serious complications which can be reduced by proper selection of patients, detailed plan and skilful performance of surgery in experienced hands and meticulous postoperative care.

Endoscopic Third Ventriculostomy in 250 Adults With Hydrocephalus

“…There were no cases of postoperative hypothalamic storm, hyperthermia, or diabetes insipidus in our series, although these complications have been reported by others. [64][65][66]72 In the current 250 intended procedures for ETV, there were no cases of postoperative parenchymal or intraventricular hematomas related to the ETV. All 250 patients had postoperative CT scans of the head within 24 hours.…”

Frequency and Pattern of Early Complications after Endoscopic Third Ventriculostomy in Obstructive Hydrocephalus

“…Having said that, complications like gaze palsy, fever, altered consciousness, diabetes insipidus, precocious puberty, hemiparesis, memory disorders, weight gain and bleeding have been reported. [11][12][13] Other complications, which are presented by some other researchers in this filed are, intraventricular, intracerebral, or subdural hemorrhage, hypothalamic injury, CSF leak, basilar artery injury, CNS infection, subdural hygroma or hematoma, headache due to sub dural air collection over the frontal cortex, and epilepsy, having a complication rate with the frequency of 8.5%. 12 The aim of the current study was to address the ETV in obstructive hydrocephalus patients in terms of determining the pattern and frequency of the complications as well as the outcome of the procedure.…”

“…[11][12][13] Other complications, which are presented by some other researchers in this filed are, intraventricular, intracerebral, or subdural hemorrhage, hypothalamic injury, CSF leak, basilar artery injury, CNS infection, subdural hygroma or hematoma, headache due to sub dural air collection over the frontal cortex, and epilepsy, having a complication rate with the frequency of 8.5%. 12 The aim of the current study was to address the ETV in obstructive hydrocephalus patients in terms of determining the pattern and frequency of the complications as well as the outcome of the procedure. Furthermore, to assess the improvement in the level of care for patient of obstructive hydrocephalus.…”

“…The complication rate of our study is compatible with the literature. 11,12 The reported frequencies of CSF leak after ETV for obstructive hydrocephalus include 1.8%, 5.16% and 10.2%. 13,15,16 In our study, the rate of CSF leak was 5% (8 patients).…”

“…Our sample size was 160 cases with 95% confidence interval, 4.4% margin of error and 8.8% proportion of complication rate using World Health Organization (WHO) sample size calculations. 12 The consecutive non probability sampling technique was used.…”