Intracranial pressure patterns after endoscopic third ventriculostomy. Preliminary experience

Area of Science:

• Neurosurgery
• Neurology
• Medical Devices

Background:

• Endoscopic Third Ventriculostomy (ETV) is a primary treatment for non-communicating hydrocephalus, offering high success rates and low complication rates.
• Traditional neuro-imaging has limitations in early postoperative assessment of ETV success.
• Postoperative intracranial pressure (ICP) monitoring is a suggested method for evaluating ETV outcomes.

Purpose of the Study:

• To investigate the relationship between ICP patterns and ETV stoma functioning.
• To explore the potential of ICP monitoring in predicting ETV success.
• To identify optimal postoperative care standards following ETV.

Main Methods:

• 26 patients with obstructive triventricular hydrocephalus underwent ETV.
• Patient groups included aqueductal stenosis, shunt malfunctions, third ventricle masses, intraventricular cysts, and external aqueductal stenosis.
• All patients had postoperative ICP monitoring via a ventricular catheter.

Main Results:

• 50% of patients experienced transient ICP rises post-ETV, often managed with CSF removal.
• ICP trends post-ETV varied significantly among patient groups.
• Patients with external aqueductal stenosis showed the best ICP outcomes, while those with intraventricular masses or shunt dependence exhibited a higher risk of intracranial hypertension.

Conclusions:

• Postoperative ICP monitoring is recommended for patients with shunt malfunction or intraventricular masses due to their higher risk of intracranial hypertension after ETV.
• Current ICP patterns observed post-ETV do not reliably predict procedural success.
• Continuous ICP monitoring in all ETV patients is encouraged to fully characterize ICP patterns.