title: Laser-assisted endoscopic third ventriculostomy: long-term results in a series of 202 patients.
abstract: OBJECTIVE
  Endoscopic third ventriculostomy is a well-known surgical option in the treatment of noncommunicating hydrocephalus. We studied complications and long-term success in 202 patients to demonstrate the safety and efficacy of laser-assisted endoscopic third ventriculostomy (LA-ETV) using a unique "black" fiber tip/diode laser combination for controlled tissue ablation.
  
  
  METHODS
  We studied 213 LA-ETVs, which were performed in 202 patients. Patients' ages ranged from 2 days to 83 years (mean age, 27 yr). The mean follow-up period for all patients was 2.7 years (range, 2 d to 12 yr). Hydrocephalus was caused by aqueductal stenosis in 65 patients, tumors in 67 patients, hemorrhages in 24 patients, myelomeningoceles in 20 patients, cysts in 15 patients, and other causes in 11 patients. The long-term effectiveness of LA-ETV was studied with Kaplan-Meier analysis.
  
  
  RESULTS
  Technically successful LA-ETVs were accomplished in 196 of the 202 patients (97%). The overall success rate for a functional LA-ETV was 68% at the 2-year follow-up evaluation. LA-ETV was more effective in patients aged 1 year and older (70% success rate) than in younger patients (59% success rate). Success rates were greater in patients with aqueductal stenosis or tumors as compared to other etiologies. Complications occurred in 22 procedures (10.3%). Only one patient (0.5%) experienced a major complication. No surgical mortalities or laser-related complications occurred.
  
  
  CONCLUSIONS
  This study demonstrates that LA-ETV is a safe and effective procedure that is comparable to other techniques for ETV. LA-ETV is most effective in patients aged 1 year and older and in patients with aqueductal stenosis and tumors, with a low major complication rate.
authors.affiliation: Department of Neurosurgery, University Medical Center, Utrecht, The Netherlands. J.vanBeijnum@gmail.com
authors.forename: Janneke
authors.initials: J
authors.lastname: van Beijnum
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Hanlo
authors.forename: Kathelijn
authors.initials: K
authors.lastname: Fischer
authors.forename: Mohsen M
authors.initials: MM
authors.lastname: Majidpour
authors.forename: Marlous F
authors.initials: MF
authors.lastname: Kortekaas
authors.forename: Rudolf M
authors.initials: RM
authors.lastname: Verdaasdonk
authors.forename: W Peter
authors.initials: WP
authors.lastname: Vandertop
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D007834:Lasers; D008297:Male; D008875:Middle Aged; D044583:Neuroendoscopy / Q000379:methods; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D020542:Third Ventricle / Q000473:pathology / Q000601:surgery*; D014696:Ventriculostomy / Q000009:adverse effects / Q000379:methods