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61st Annual Meeting of the German Society of Neurosurgery (DGNC) as part of the Neurowoche 2010
Joint Meeting with the Brazilian Society of Neurosurgery on the 20 September 2010

German Society of Neurosurgery (DGNC)

21 - 25 September 2010, Mannheim

Navigation- and laser-assisted neuroendoscopy in the management of complex hydrocephalus

Meeting Abstract

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  • Hans Christoph Ludwig - Klinik für Neurochirurgie, Universitätsmedizin Göttingen, Deutschland
  • Timo Behm - Klinik für Neurochirurgie, Universitätsmedizin Göttingen, Deutschland
  • Veit Rohde - Klinik für Neurochirurgie, Universitätsmedizin Göttingen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocV1612

DOI: 10.3205/10dgnc085, URN: urn:nbn:de:0183-10dgnc0859

Published: September 16, 2010

© 2010 Ludwig 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: In complex multiloculated hydrocephalus and intracranial cysts endoscopic procedures are a viable alternative to shunt operations which have a high complication rate due to the necessity to implant multiple catheters in the majority of patients. Endoscopy allows fenestration of membranes for unhindered communication between different CSF-compartments, resulting either in avoidance of shunt implantation at all or reduction of the required number of ventricular catheters to one. Interestingly, large clinical series dealing with the endoscopic management of multiloculated hydrocephalus are missing so far.

Methods: From 2002 to 2010, 70 patients (mean age 17.5 years), mostly with post-haemorrhagic or post-infectious hydrocephalus and congenital cysts, underwent endoscopic cystocystostomy, cystoventriculostomy and/or cystocisternostomy, using a 2.0 µ fibre conducted laser. Mean follow up time was 4.7 years. Neuronavigation was used in 95% of the procedures. In some cases ETV, pellucidotomy and the rescue of lost or fixed catheters were additionally performed via the endoscope.

Results: Overall, 17 of the 70 patients needed no further shunt. In 21 patients with untreated hydrocephalus, only one ventricular catheter which lined up the cysts was sufficient. Simplification of a previous multiple-catheter shunt was possible in 25 children. In 10 children the development of a new cyst was observed and treated by reendoscopy (6) or microsurgery (4). Beside one transient hemiparesis we did not observe any morbidity or mortality. Neuronavigation was essential in most cases.

Conclusions: Fenestration of cysts in multiloculated hydrocephalus using the laser via the endoscope is a highly effective and safe treatment option, which allows either to avoid a shunt or, in the majority of patients, to simplify the implanted shunt system which then is less prone to complications. Neuronavigation and laser are important tools for a successful operation.