title: Cranial growth restriction, a fundamental measure for success of the endoscopy in children under 1 month of age. Is it possible to improve the outcome?
abstract: BACKGROUND
  Endoscopic third ventriculostomy has been shown to be efficient for the treatment of non-communicating hydrocephalus. However, it is not recommended as the first option in the treatment of obstructive hydrocephalus in children under 3 months of age, because the success rate is less than 35%.
  
  
  METHODS
  We reviewed all the cases of triventricular hydrocephalus treated between 2007 and 2011 in patients under 1 month of age in the case of normal term births or under 1 month of corrected age, in the case of pre-term births. The first treatment option was endoscopic fenestration and a restriction of cranial volume during the two months after surgery.
  
  
  RESULTS
  Ten patients under 1 month of age underwent 13 ventriculostomies for non-communicating hydrocephalus of varying etiology (suprasellar arachnoid cyst (3), stenosis of the Sylvian aqueduct (2), post-infectious meningitis (3), and intrauterine bleeding (2)). Three required surgical endoscopic revision at 3, 4, and 5 months, respectively, after the initial surgery due to progressive ventricular enlargement. One of these three patients presented with Klebsiella pneumoniae ventriculitis as a complication after the second endoscopy. After a mean follow-up of 32 months, none has required a shunt.
  
  
  CONCLUSIONS
  In our limited experience in triventricular hydrocephalus in patients under 1 month, the third ventriculostomy technique may be a better option than the shunt in selected cases.
authors.affiliation: Pediatrics Neurosurgery Unit, Neurosurgery Department, Virgen del Rocío Hospital, C/Manuel Siurot s/n. 41013 Seville. Spain. monicargarvia@msn.com
authors.forename: Mónica
authors.initials: M
authors.lastname: Rivero-Garvía
authors.forename: Javier
authors.initials: J
authors.lastname: Márquez-Rivas
authors.forename: Ana Belén
authors.initials: AB
authors.lastname: Rueda Torres
authors.forename: Raquel
authors.initials: R
authors.lastname: Gutiérrez-González
authors.forename: Antonia
authors.initials: A
authors.lastname: García-Iglesias
authors.forename: Daniel
authors.initials: D
authors.lastname: Pascual-Argente
authors.forename: Maikal
authors.initials: M
authors.lastname: Villena
authors.forename: María
authors.initials: M
authors.lastname: Regueiras
authors.forename: Diego
authors.initials: D
authors.lastname: Medina
mesh_terms: D000367:Age Factors; D004724:Endoscopy; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery*; D007231:Infant, Newborn; D008297:Male; D012886:Skull / Q000254:growth & development; D016896:Treatment Outcome; D014696:Ventriculostomy / Q000379:methods*
keywords: Cranial growth restriction; Endoscopy; Hydrocephalus; Neonate; Shunt; Third ventriculostomy