Neuroendoscopic third ventriculostomy. A practical alternative to extracranial shunts in non-communicating hydrocephalus.
The outcomes in 103 patients who have undergone third ventriculostomy for non-communicating hydrocephalus at our institution form 1978-1994 have been analysed. The group has been sub-divided by age, cause of hydrocephalus and whether the third ventriculostomy was the initial definitive procedure or whether progression of their hydrocephalus had been arrested for a long time (usually years) by an extracranial shunt prior to third ventriculostomy. At the time of shunt malfunction (usually blockage) a third ventriculostomy was performed if the anatomy was, or could be made suitable for the safe performance of the procedure. Third ventriculostomy under the age of 6 months was successful in only 8 of 25 patients. Seventeen patients in whom the onset of hydrocephalus was under the age of six months and the ventriculostomy was performed between 6 months and 18 years, 8 were successful. Sixteen of these had had previous long term shunts. In 40 patients in whom the onset of hydrocephalus was over the age of 6 months and the ventriculostomy performed after the age of 19 years, 32 were successful. In 28 patients over the age of 20 years, 13 had previously been shunted and in 8 of these the procedure was successful. In 15 patients not previously shunted, 9 ventriculostomies were successful. Three failed, 2 died before evaluation could be done and one was lost to follow-up. There were no deaths caused by the procedure. Two patients suffered from a hemiparesis, (1 transient) 1 patient suffered mid-brain damage. There were 2 subdural effusions. Two patients had infections, 1 superficial and 1 a ventriculitis.
Jones
R F
RF
Department of Neurosurgery, Prince of Wales Children's Hospital, Sydney, Australia.
Kwok
B C
BC
Stening
W A
WA
Vonau
M
M
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001925:Brain Damage, Chronic / Q000209:etiology; D002557:Cerebrospinal Fluid Shunts / Q000295:instrumentation*; D002648:Child; D002675:Child, Preschool; D019723:Endoscopes; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery*; D007223:Infant; D007427:Intracranial Pressure / Q000502:physiology; D008297:Male; D009460:Neurologic Examination; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D012086:Reoperation; D017211:Treatment Failure; D014696:Ventriculostomy / Q000295:instrumentation*; D014741:Video Recording / Q000295:instrumentation