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55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

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Hydrocephalus grading system to predict the outcome of third ventriculostomy

Hydrozephalus-Grading-System zur Vorhersage der Erfolgsquote der Ventrikulozisternostomie

Meeting Abstract

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  • corresponding author Uwe Kehler - Klinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
  • J. Regelsberger - Klinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
  • J. Gliemroth - Klinik für Neurochirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck
  • M. Westphal - Klinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf, Hamburg

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocMO.02.08

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2004/04dgnc0033.shtml

Published: April 23, 2004

© 2004 Kehler et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

Text

Objective

Success and failure of third ventriculostomy (TVS) depends strongly on patient selection. TVS is generally accepted in acquired aqueductal stenosis, however, there is no consent about TVS in newborns, Chiari malformations, posthemorrhagic, and postmeningitic hydrocephalus etc. The aim of a new simple, broadly applicable hydrocephalus grading is to predict the outcome of TVS based on morphological and clinical parameters detached from the conventional etiological criterias.

Methods

The hydrocephalus is graded on the base of the extent of downward bulging of the floor of the third ventricle (normal position:0; downward bulging up to 5mm:1; >5mm: 2 points); the direct visualization of the CSF-pathway obstruction (no:0 or yes: 1 point), and progression of clinical symptoms (no:1, yes: 2 points). The sum determines the grade - resulting in five grades. In this proposed grading system in grade 1 and 2 (cases with no downward bulging floor and/or with no direct visible obstruction) no indication for TVS was seen. The grading was evaluated with a series of 72 TVS performed in hydrocephalus grades 3,4, and 5. The results of TVS was classified in good: clinical improvement with shunt independence or failed: shunt dependence. Statistical analysis was done with Fisher's exact test.

Results

Grade 5 showed good outcome of TVS (shunt independence) in 95%, Grade 4 in 58% and Grade 3 in 40%. The difference is highly significant (p<0,01).

Conclusions

Retrospective application of this grading scheme to a series of TVS has demonstrated its high correlation with the outcome and may settle the controversies in patient selection for TVS or in selection of the adequate hydrocephalus therapy: TVS or shunt. Prospective evaluation is on the way.