Influence of the State of the Subarachnoid Space of the Cranial Base in Hydrocephalus Resolution after Endoscopy.
ObjectiveTo compare the resolution rate of hydrocephalus after endoscopy (predominantly endoscopic third ventriculostomy [ETV]) using flexible endoscopes during a 5-year period in patients with a permeable and a nonpermeable subarachnoid space (SAS).Material and MethodsWe conducted a retrospective cohort study of the videos and records of 150 hydrocephalic patients chosen randomly who underwent ETV (and other endoscopic procedures) with a flexible endoscope. The patients were classified into two groups based on the neuroendoscopic findings. The first group included patients with a permeable SAS, and the second group included patients with a nonpermeable SAS. A normal SAS or one with slight arachnoiditis was considered permeable. Adhesive arachnoiditis and immature or mechanically obliterated SASs were considered nonpermeable.ResultsWe found a success rate of 70% in patients with a permeable SAS versus 33% in patients with a nonpermeable SAS. The baseline characteristics of both groups were homogeneous. We obtained a statistically significant difference (p< 0.0001) with hazard ratio (HR) 3.42 (95% confidence interval [CI], 1.88-6.22). Another important factor involved was age that showed a statistically significant difference (p< 0.0018) with HR 3.28 (95% CI, 1.55-6.93).ConclusionThe permeability of the SAS is an important prognostic factor in the resolution rate of hydrocephalus after ETV (and other endoscopic procedures) using flexible neuroendoscopes. Therefore we recommend that the characteristics of the SAS be examined following every endoscopic procedure for hydrocephalus to identify patients at risk of recurrence.
Department of Neurosurgery, Bathildis Krankenhaus Bad Pyrmont, Bad Pyrmont, Lower Saxony, Germany.
Jose Juan
JJ
Sanchez Rodriguez
Department of Neurosurgery, Hospital Central Dr. Ignacio Morones Prieto, Mexico, San Luis Potosi, Germany.
Jaime
J
Torres-Corzo
Department of Neurosurgery, Hospital Central Dr. Ignacio Morones Prieto, Mexico, San Luis Potosi, Germany.
Dominic Shelby
DS
Cervantes
Department of Neurosurgery, Hospital Central Dr. Ignacio Morones Prieto, Mexico, San Luis Potosi, Germany.
Roberto
R
Rodriguez-DellaVecchia
Department of Clinical Epidemiology, Faculty of Medicine, San Luis Potosi, San Luis Potosi, Mexico.
Antonio
A
Gordillo-Moscoso
Department of Neurosurgery, University Clinic Evangelic Hospital Oldenburg, Oldenburg, Lower Saxony, Germany.
Juan Manuel
JM
Vinas-Rios
Department of Clinical Epidemiology, Faculty of Medicine, San Luis Potosi, San Luis Potosi, Mexico.
Martin
M
Sanchez-Aguilar
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000503:physiopathology* / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D044583:Neuroendoscopy; D011379:Prognosis; D012189:Retrospective Studies; D019291:Skull Base; D013346:Subarachnoid Space / Q000503:physiopathology*; D055815:Young Adult