Endoscopic third ventriculostomy in patients with secondary triventricular hydrocephalus from a haemorrhage or ischaemia in the posterior cranial fossa.
BACKGROUND
The aim of this project was to evaluate the efficacy of endoscopic third ventriculostomy (ETV) in the treatment of acute hydrocephalus caused by a haemorrhage or ischaemia in the posterior cranial fossa.


METHODS
21 patients who had acute triventricular hydrocephalus resulting from ischaemia in 8 cases, and from cerebellar haemorrhage in 13 cases were treated with endoscopic third ventriculostomy. This series was compared with a control group of 30 patients, with clinical neuroradiological characteristics comparable to the preceding group (18 acute post-haemorrhage hydrocephalus and 12 post-ischaemia in the posterior cranial fossa), treated by external ventricular drainage (EVD). All patients were monitored clinically and by brain computed axial tomography (CT) to measure the dimensions of the lateral and third ventricles. The criteria used to define efficacy were based on the image of the postoperative cerebral CT scan.


RESULTS
No patient suffered haemorrhagic complications from surgical procedures or additional neurological deficits. There was no postoperative mortality or added morbidity. In all cases there was an improvement of intracranial hypertension. Clinical improvement was associated with a reduction of the ventricular dimensions documented by serial CT scans.


CONCLUSIONS
We consider that, in selected cases, ETV can be suggested as the first choice treatment instead of the classic EVD. In the overall management of such patients, ETV has no or a very low rate of complications and allows shorter hospitalisation and earlier transfer to rehabilitative structures.
Vindigni
M
M
Department of Neurosurgery, Azienda Ospedaliero Universitaria di Udine, Udine, Italy. vindigni.marco@aoud.sanita.fvg.it
Tuniz
F
F
Ius
T
T
Cramaro
A
A
Skrap
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D020300:Intracranial Hemorrhages / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011859:Radiography; D020542:Third Ventricle / Q000033:anatomy & histology / Q000503:physiopathology / Q000601:surgery*; D014696:Ventriculostomy / Q000295:instrumentation / Q000379:methods*; D055815:Young Adult