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59th Annual Meeting of the German Society of Neurosurgery (DGNC)
3rd Joint Meeting with the Italian Neurosurgical Society (SINch)

German Society of Neurosurgery (DGNC)

1 - 4 June 2008, Würzburg

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Endoscopic third ventriculostomy: Indications, treatment and outcome in a series of 48 patients

Endoskopische Ventrikulozisternostomie: Indikationen, Vorgehen und Outcome in einer Serie von 48 Patienten

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  • corresponding author S. Sarikaya-Seiwert - Neurochirurgische Klinik, Klinikum der Heinrich-Heine-Universität, Düsseldorf
  • A. M. Messing-Jünger - Abteilung für Neurochirurgie, Asklepios Kinderklinik Sankt Augustin
  • H.-J. Steiger - Neurochirurgische Klinik, Klinikum der Heinrich-Heine-Universität, Düsseldorf

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocMO.03.07

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2008/08dgnc056.shtml

Published: May 30, 2008

© 2008 Sarikaya-Seiwert 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

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Objective: Different diseases may lead to obstructive hydrocephalus for which endoscopic third ventriculostomy (ETV) is an established therapy. The evaluation of neurological symptoms and MRI scans with phase contrast sequence are presently being used for defining the efficacy of this method. The ventricular width is also measured as one control parameter, but may not be precise enough. Therefore, we used a new method of 3D volume measurement for determining the size of CSF spaces and brain tissue.

Methods: Between 2003 and 2006 48 patients with obstructive hydrocephalus were treated with ETV (mean age 29). 21 (43,8%) patients suffered obstructive hydrocephalus caused by primary aqueductal stenosis (group 1), 23 (47,9%) patients had tumor related aqueductal stenosis (group 2) and 4 (8,3%) hemorrhage in the lamina quadrigemina region (group 3). MRI scans were performed during follow-up (3 months, 6 months, annually after surgery). Using a 3D MRI sequence, the volume of the supratentorial brain tissue and ventricles were determined before and after surgery. Ratios were calculated by dividing the volumes of the brain tissue by the volumes of the ventricles. A segmentation program (ITKsnap-screen) was used to measure these volumes. In addition the patency of the stoma was examined.

Results: All patients of group 1 and 2 benefited from ETV. 18 (78,3%) patients in group 2 showed a significant increase of the tissue to ventricle ratio (p<0,05) on follow-up MRI 3 months after surgery. Group 1 also showed an increase of the ratio. 6 months after surgery additional increases of the ratio were less evident in both groups. 12 months after surgery and in the annual follow up examinations no further increases could be measured. 3 (75%) patients of group 3 were treated by ventriculo-peritoneal shunts because of ETV insufficiency.

Conclusions: The increase of the tissue to ventricle ratio is a useful parameter for the resolution of hydrocephalus after ETV. Our study demonstrates that obstructive hydrocephalus resolves faster in cases associated with tumors compared to chronic obstructive hydrocephalus. The method for volume measurement employed in our study was able to detect even slight changes in the obstructive hydrocephalus.