gms | German Medical Science

Objective: Endoscopic third ventriculostomy (ETV) is the treatment of choice for occlusive hydrocephalus. The procedure can be regarded as successful when ventricular size diminishes, patients clinically improve and no further operations like shunt insertions become necessary. With correct indication, success rate is considered to be up to 80%. Several reasons for ETV-failures are described in the literature, whereas information regarding the intracranial pressure (ICP) is still lacking. Therefore, the aim of the study was to compare long-term ICP profiles of ETV-responders and non-responders.

Methods: A total of 40 patients suffering from occlusive hydrocephalus underwent insertion of a telemetric ICP measurement probe (Raumedic Neurovent P-tel). The devices were implanted either a few days prior to ETV or parallel to the endoscopic procedure. After ETV, all patients were regularly followed-up including telemetric ICP measurements and clinical examinations. Clinical improvement and no further surgery were considered as ETV success. Patients who underwent Re-ETV or secondary shunt insertion were seen as non-responders (ETV failure).

Results: In this series, ETV succeeded in 31 and failed in 9 patients. Retrospective comparison of the ICP profiles of responders and non-responders could reveal interesting differences. The mean ICP could not be proven being a predictive value to differentiate between ETV-success and failure. Frequent ICP elevations > 15 mmHg were indicative for failed endoscopy.

Conclusion: Telemetric long-term ICP monitoring enables a sufficient postoperative care management. Repetitive measurements and thorough analyses of special ICP parameters may early recognize ETV non-responders.