Water jet dissection technique for endoscopic third ventriculostomy minimises the risk of bleeding and neurological complications in obstructive hydrocephalus with a thick and opaque third ventricle floor.
BACKGROUND
Endoscopic third ventriculostomy (ETV) is a procedure of choice in the treatment of obstructive hydrocephalus. Neurovascular injury while perforating the ventricular floor can occur when using a conventional probe, especially in patients with a thick and opaque third ventricle floor. The water jet dissection technique can be useful in such cases to perform an initial perforation.


METHODS
The water jet dissection technique was used to perform ETV in 36 patients with obstructive hydrocephalus with a thick and opaque third ventricle floor over a 3-year period. A water jet was generated using a syringe connected to a 2-mm catheter.


RESULTS
The water jet dissection technique successfully created a patent ETV stoma in 31 patients. 5 patients needed a re-operation due to a blocked stoma. There were no complications related to the procedure. An improvement in clinical function was seen in 28 (83.3%) patients at a median follow-up of 29 months.


CONCLUSIONS
The water jet dissection is a useful technique while performing ETV to prevent neurovascular injury. Our improvised technique of creating a water jet is safe, inexpensive, readily available and can be practiced at any centre performing ETV.
Department of Neurosurgery, NSCB Medical College and Hospital, Jabalpur, India.
Y R
YR
Yadav
R
R
Shenoy
G
G
Mukerji
V
V
Parihar
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery*; D007223:Infant; D008297:Male; D008875:Middle Aged; D044583:Neuroendoscopy / Q000009:adverse effects / Q000379:methods*; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D020542:Third Ventricle / Q000601:surgery*; D016896:Treatment Outcome; D014696:Ventriculostomy / Q000009:adverse effects / Q000379:methods*