title: Transventricular neuroendoscopic exploration and biopsy of the basal cisterns in patients with Basal meningitis and hydrocephalus.
abstract: BACKGROUND
  Management of communicating hydrocephalus associated with infectious meningitis and arachnoiditis of the basal cisterns can be challenging if no microorganism or pathological diagnosis is established. The purpose of our series is to elucidate the efficacy of endoscopic basal cistern exploration, biopsy, and endoscopic third ventriculostomy (ETV) in patients with basal cistern meningitis and hydrocephalus.
  
  
  METHODS
  Between 2005 and 2010, all patients who underwent transventricular endoscopic exploration biopsy and biopsy of the basal cisterns were analyzed and prospectively followed up. Particular attention was given to neuroendoscopic findings, sensitivity of biopsy, and the role of ETV.
  
  
  RESULTS
  Twenty-four patients, ranging in age from 2 to 63 years, underwent transventricular endoscopic biopsy and exploration of the basal cisterns. All patients had negative cerebrospinal fluid analysis obtained by lumbar puncture. Successful ETV, exploration, dissection, and biopsy of the basal cisterns were performed successfully in all patients with a flexible neuroendoscope. Neuroendoscopic findings included: unusually thick Liliequist membrane, moderate to severe adhesive arachnoiditis, inflammatory and cotton-like exudates, granulations, and narrow subarachnoid space. Definitive histopathological diagnosis from the basal cisterns specimen was obtained in 79% of patients. There were no complications related to the procedure. At 15 months of follow-up, 70% of the patients with hydrocephalus did not require a ventriculoperitoneal shunt.
  
  
  CONCLUSIONS
  Endoscopic transventricular basal cisterns exploration is feasible with a flexible neuroendoscope. It is a viable alternative in the management of patients with basal cistern meningitis and arachnoiditis without histopathological diagnosis. It yields to an accurate diagnosis in 79% of the patients. ETV is a good alternative in the management of intracisternal extraventricular obstructive hydrocephalus.
authors: Department of Neurosurgery, Facultad de Medicina, Universidad Autonoma de San Luis Potosi, San Luis Potosi, Mexico.
authors: Jaime
authors: J
authors: Torres-Corzo
authors: Juan Manuel
authors: JM
authors: Viñas-Rios
authors: Martin
authors: M
authors: Sanchez-Aguilar
authors: Roberto Rodriguez-Della
authors: RR
authors: Vecchia
authors: Juan Carlos
authors: JC
authors: Chalita-Williams
authors: Leonardo
authors: L
authors: Rangel-Castilla
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000768:Anesthesia, General; D001099:Arachnoid / Q000473:pathology; D001100:Arachnoiditis / Q000601:surgery; D001706:Biopsy; D002540:Cerebral Cortex / Q000473:pathology / Q000601:surgery; D002552:Cerebral Ventricles / Q000601:surgery*; D002555:Cerebrospinal Fluid / Q000737:chemistry / Q000166:cytology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004388:Dura Mater / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006849:Hydrocephalus / Q000473:pathology* / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008581:Meningitis / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D001523:Mental Disorders / Q000209:etiology / Q000523:psychology; D008875:Middle Aged; D044583:Neuroendoscopy / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome