Endoscopic third ventriculostomy in idiopathic normal pressure hydrocephalus: an Italian multicenter study.
OBJECTIVE
The aim of the report is to define the indications and results of endoscopic third ventriculostomy (ETV) in idiopathic normal pressure hydrocephalus and to discuss the physiopathological mechanism of this procedure.


METHODS
The cases of 110 patients with idiopathic normal pressure hydrocephalus who underwent ETV in four Italian neurosurgical centers were retrospectively reviewed. The postoperative outcome was correlated with patient age, length of clinical history, preoperative clinical score, symptoms of clinical onset, type of hydrocephalus, and intraoperative findings.


RESULTS
The follow-up period ranged from 2 to 12 years (average, 6.5 yr). The outcome evaluation was made 2 years after the procedure. Postoperative clinical improvement occurred in 76 (69.1%) of 110 patients. There was no correlation between success rate and patient age or type of ventricular enlargement (normal or enlarged fourth ventricle). Conversely, the rate of neurological improvement was higher in patients with shorter clinical history, better preoperative neurological score, and clinical onset with gait disturbances. Moreover, the intraoperative finding of the sudden reappearance of normal cerebral pulsations and significant downward and upward movements of the third ventricular floor after ETV was also correlated with a good outcome.


CONCLUSIONS
ETV results in a relatively high rate of clinical improvement and a low complication rate in patients with idiopathic normal pressure hydrocephalus. Therefore, it may be easily performed with the same approach used for intracranial pressure monitoring with low morbidity. However, our data must be confirmed by additional studies.
Gangemi
Michelangelo
M
Department of Neurological Sciences, Section of Neurosurgery, Federico II University School of Medicine, Naples, Italy. mgangemi@unina.it
Maiuri
Francesco
F
Naddeo
Michele
M
Godano
Umberto
U
Mascari
Carmelo
C
Broggi
Giovanni
G
Ferroli
Paolo
P
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000473:pathology / Q000601:surgery*; D007558:Italy; D008297:Male; D008875:Middle Aged; D044583:Neuroendoscopy / Q000379:methods*; D012189:Retrospective Studies; D020542:Third Ventricle / Q000473:pathology / Q000601:surgery*; D014696:Ventriculostomy / Q000379:methods*