title: Resolution of papilledema after endoscopic third ventriculostomy versus cerebrospinal fluid shunting in hydrocephalus: a comparative study.
abstract: OBJECTIVE
  In this study the authors compare the efficacy of endoscopic third ventriculostomy (ETV) versus CSF shunting for resolution of papilledema in hydrocephalus.
  
  
  METHODS
  This comparative case series study recruited 12 patients (24 eyes) with hydrocephalus who underwent either an ETV (Group 1, 6 patients [12 eyes]) or CSF shunt treatment (Group 2, 6 patients [12 eyes]). A complete ophthalmological examination including retinal nerve fiber layer (RNFL) evaluation by optical coherence tomography was provided for all patients before surgery and in the 1st week, 1st month, and 3rd month postoperatively. The 2 groups were compared for quantitative changes in RNFL thickness and, thereby, resolution of papilledema. Statistical evaluation was performed using the Mann-Whitney U-test with the aid of SPSS version 16.0.
  
  
  RESULTS
  The mean preoperative RNFL thickness was 259.7 ± 35.8 μm in Group 1 and 244.5 ± 53.4 μm in Group 2 (p = 0.798). The mean decrease in RNFL thickness was 101.3 ± 38.8 μm, 141.2 ± 34.6 μm, and 162.0 ± 35.9 μm in Group 1 versus 97.0 ± 44.6 μm, 143 ± 45.6 μm, and 130.0 ± 59.8 μm in Group 2 for the postoperative 1st week, 1st month, and 3rd month, respectively. There was no significant difference between the two groups with respect to decrease in RNFL thickness during the 1st week, 1st month, and 3rd month (p = 0.563, p = 0.753, and p = 0.528, respectively).
  
  
  CONCLUSIONS
  This is the first study to quantitatively evaluate papilledema in assessing the success of ETV and CSF shunting. The authors' results indicated that ETV is as effective as CSF shunting with respect to decreasing intracranial pressure and resolution of papilledema.
authors.affiliation: Departments of Neurosurgery and.
authors.forename: Ender
authors.initials: E
authors.lastname: Koktekir
authors.forename: Bengu Ekinci
authors.initials: BE
authors.lastname: Koktekir
authors.forename: Hakan
authors.initials: H
authors.lastname: Karabagli
authors.forename: Sansal
authors.initials: S
authors.lastname: Gedik
authors.forename: Gokhan
authors.initials: G
authors.lastname: Akdemir
mesh_terms: D000293:Adolescent; D000328:Adult; D002557:Cerebrospinal Fluid Shunts; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D015994:Incidence; D007427:Intracranial Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D009900:Optic Nerve / Q000503:physiopathology; D010211:Papilledema / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D011446:Prospective Studies; D020542:Third Ventricle / Q000601:surgery*; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014696:Ventriculostomy; D055815:Young Adult
keywords: CSF shunting; ETV = endoscopic third ventriculostomy; ICP = intracranial pressure; OCT = optical coherence tomography; ONSD = optic nerve sheath diameter; RNFL = retinal nerve fiber layer; endoscopic third ventriculostomy; hydrocephalus; intracranial pressure; papilledema