gms | German Medical Science

Objective: Endoscopic third ventriculostomy (ETV) is the treatment of choice in occlusive hydrocephalus. Different methods for monitoring the postoperative course have been proposed, but most of them could be proven to have low predictive values. The aim of the presented study was to evaluate whether long-term intracranial pressure (ICP) monitoring can reliably identify differences between ETV-responders and -nonresponders.

Method: Twenty-nine patients suffering from occlusive hydrocephalus were treated by ETV and thereafter regularly followed-up with telemetric long-term ICP measurements. Target parameters have been mean ICP, pulse pressure amplitude and percentage of pressure peaks exceeding 15 mmHg. ICP profiles were retrospectively compared to the clinical outcome of the patients.

Results: In this cohort, ETV succeeded in 24 and failed in 5 patients. Significant differences in ICP profile between clinical successes and failures could be revealed 6 weeks after surgery. ETV-responders showed a clear tendency of pressure, amplitude and peak reduction over time. Unsuccessful surgery was associated with a mean ICP and pulse pressure amplitude above 5 mmHg. More than 5% of ICP values exceeding 15 mmHg were also indicative for ETV failure.

Conclusions: Repetitive telemetric ICP measurements after ETV could reveal significant differences in the ICP-profile of ETV-responders and -nonresponders. Contrary to other methods and techniques, the analysis of the long-term ICP profile seems to be well suited for predicting the later clinical outcome.