Initial management of hydrocephalus associated with Chiari malformation Type I-syringomyelia complex via endoscopic third ventriculostomy: an outcome analysis.
OBJECTIVE
The aim of this study was to evaluate the efficacy of endoscopic third ventriculostomy (ETV) in patients with Chiari malformation Type I (CM-I) and hydrocephalus with or without syringomyelia.


METHODS
The authors identified, in a prospective endoscopy database, 16 adults and children (age range 2-68 years) with CM-I and hydrocephalus that had been managed with ETV. They reviewed the clinical features and radiographic findings for all patients. Fifteen patients underwent ETV as a primary treatment, whereas 1 patient underwent the procedure at the time of shunt failure. All patients had symptomatic hydrocephalus with either aqueductal or fourth ventricular outflow obstruction. The mean duration of follow-up was 42 months.


RESULTS
Fifteen patients (94%) remain shunt free following ETV for CM-I. Five (83%) of the 6 patients with a syrinx had improvement or resolution of the syrinx following ETV. Six patients (37.5%) underwent foramen magnum decompression for persistent CM-I -- or syrinx-related symptoms. There was no cerebrospinal fluid leakage or intracranial pressure-related problem following foramen magnum decompression.


CONCLUSIONS
Endoscopic third ventriculostomy provides a durable method of treatment for hydrocephalus associated with CM-I. It is effective as a primary treatment, and the authors advocate its use as a replacement for routine ventriculoperitoneal shunt insertion in these patients. Management of the hydrocephalus alone is often sufficient and may obviate decompression, although a significant proportion of patients will still need both procedures.
Department of Neurosurgery, The Walton Centre for Neurology and Neurosurgery, Liverpool, UK. carolinehayhurst@hotmail.com
Caroline
C
Hayhurst
Jibril
J
Osman-Farah
Kumar
K
Das
Conor
C
Mallucci
D000293:Adolescent; D000328:Adult; D000368:Aged; D001139:Arnold-Chiari Malformation / Q000150:complications* / Q000473:pathology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D019299:Decompression, Surgical; D004724:Endoscopy; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D012189:Retrospective Studies; D013595:Syringomyelia / Q000150:complications* / Q000473:pathology / Q000601:surgery; D020542:Third Ventricle / Q000601:surgery*; D016896:Treatment Outcome; D014696:Ventriculostomy