Neuroendoscopy in the treatment of obstructive hydrocephaly.

Abstract

The purpose of this study was to determine the safety and efficacy in the first sixteen patients operated by endoscopic third ventriculostomy for triventricular obstructive hydrocephalus in the Hospital of S. João-Porto.Operated from December 1998 to December 1999, there were one adult, one teenager and 14 children, with a average age of 18 months in the paediatric group. The three major causes for the changed CSF dynamics in this 16 patients were: three had aqueductal congenital stenosis; nine had aqueductal acquired obstruction (three with post-infectious occlusion, three with tumours, two with intraventricular cysts and one with a pineal arteriovenous malformation), and four with obstruction of the basal arachnoidal cisterns associated with myelomeningocele.The endoscopic third ventriculostomy (ETV) was concluded in 15 of the selected cases (it was not possible in a new-born with hydrocephalus after bacterial meningitis), and it was repeated in two patients. The success rate (clinical efficacy of the procedure) was 9/15 (60%), and the mean follow-up was 9.1 months (range from three to 15 months).ETV is a efficient method in the treatment of non-communicant hydrocephalus. The safety and low-time consuming of this technique, avoiding the shunt disease, makes it desirable specially in paediatrics patients, or even in the case of different cases of hydrocephalus were some obstructive factor could be identified. So, some patients with a previous shunt or with a diagnosis of myelomeningocele, can benefit with this procedure.