Article
Third ventriculostomy for the treatment of hydrocephalus: Results of 271 procedures
Endoskopische Drittventrikulostomie zur Therapie des Hydrozephalus: Ergebnisse nach 271 Operationen
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Authors
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J. Oertel
- Klinik für Neurochirurgie, Nordstadtkrankenhaus Hannover
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H. Schroeder
- Klinik für Neurochirurgie, Ernst Moritz Arndt-Universität, Greifswald
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J. Baldauf
- Klinik für Neurochirurgie, Ernst Moritz Arndt-Universität, Greifswald
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M. Gaab
- Klinik für Neurochirurgie, Nordstadtkrankenhaus Hannover
| Published: | April 11, 2007 |
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Outline
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Objective: The indication for endoscopic third ventriculostomy includes almost any hydrocephalus. Depending on the underlying pathology a highly variable outcome has been reported. Here, the authors present their experience with endoscopic third ventriculostomy in the treatment of hydrocephalus after application of this technique for 13 years.
Methods: Between January 1993 and October 2005, 271 third ventriculostomies were performed. Indications included obstructive hydrocephalus caused by tumor, aqueductal stenosis, hemorrhage and brain infarction as well as selected cases of communicating hydrocephalus. A standard endoscopic ventriculostomy at the floor of the third ventricle consisting of a blunt perforation and subsequent enlargement of the stoma with a balloon catheter was performed.
Results: The mean age of the patients scored was 41 years with a range of 1 day up to 85 years. Over all, symptoms improved clinically in 69%; the ventricular size decreased in 64%. In one case, the procedure had to be abandoned. The success rate of the procedure is highly dependent on the underlying pathology (116 cases with obstructive hydrocephalus caused by tumor, 81% success rate; 56 cases with aqueductal stenosis, 73% success rate; 35 cases of intraventricular hemorrhage, 66% radiologic improvement; 15 cases with cerebellar infarction and fourth ventricular malformation each, 86% and 53% success rate respectively; 35% clinical improvement in 23 cases of communicating hydrocephalus; 50% improvement in 4 cases associated with myelomeningocele). Complications included 2 deaths (0.7%) and 4 permanent deficits (1.5%).
Conclusions: In all, endoscopic third ventriculostomy represents a safe and reliable procedure for hydrocephalus treatment. It is the procedure of choice for obstructive hydrocephalus.
