[Neuroendoscopy. Its usefulness in the hydrocephalus management of children in developing countries].
Hydrocephalus is a huge burden, specially in the poor countries with a big proportion of sick children with this condition, against the countries with good sanitarian conditions. In Latinamerica the most common etiological factors of hydrocephalus are associated with bad prenatal controls, neonatal sepsis and consequent meningitis and ventriculitis. The hydrocephalus is a consequence of the damage in the circulation of the cerebrospinal fluid (CSF). Neuroendoscopy specially third ventriculostomy, associated in some patients with choroid plexus cauterization, represents an alternative method to manage this condition avoiding shunts and its complications. Endoscopic third ventriculostomy (ETV) alone or with choroid plexus cauterization (CPC) is an emerging and very useful technique to manage hydrocephalus specially in children with: ventriculitis as a consequence of meningitis, myelomeningocele, obstructive hydrocephalus idiopathic or seconday to posterior fossa tumors. One hundred consecutive children (100) underwent ventriculoscopy preceding EVT as an initial treatment of hydrocephalus since January 2001 to July 2006, median age was 15.5 months with a range between 2-48 months, 55% are males of our Institution in Valencia, Venezuela. We describe the normal and pathological ventricular anatomy with emphasis in the endoscopic technique and its challenges. We present how the EVT works to prevent the shunt implantation. In the future, neuroendoscopy prevents the use of shunts to treat hydrocephalus in children, avoiding its complications and cost. Neuroendoscopy is a neurosurgical technique everyday most common to manage hydrocephalus and intraventricular lesions in the world. We report an algorythm to use in children younger than 1 year of age with postinfectious hydrocephalus (PIHC) or associated with myelomeningocele. We stress the use of EVT as an alternative because of its low cost to treat hydrocephalus avoiding the complications and dependency of shunts.
Jiménez-León
Juan C
JC
Departamento de Neurocirugía, Escuela de Medicina, Universidad de Carabobo, Valencia, Venezuela. neurojcj@gmail.com
Jiménez
Cristina S
CS
Betancourt
Yaline M
YM
D002675:Child, Preschool; D003906:Developing Countries; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000453:epidemiology / Q000601:surgery*; D007223:Infant; D008297:Male; D008591:Meningomyelocele / Q000601:surgery; D044583:Neuroendoscopy; D020542:Third Ventricle / Q000033:anatomy & histology / Q000601:surgery*; D016896:Treatment Outcome; D014687:Venezuela / Q000453:epidemiology; D017287:Ventriculoperitoneal Shunt; D014696:Ventriculostomy