Endoscopic third ventriculostomy for treatment of obstructive hydrocephalus

Endoscopic third ventriculostomy has become the preferred treatment for obstructive hydrocephalus. The purpose of this paper is to present our experience with ventriculostomy at our center.

Twenty-four patients underwent ventriculostomy for the treatment of obstructive hydrocephalus between May 2000 and May 2006. The follow-up period lasted between one and 51 (median: four) months. The mean age of the patients was 31 (range: 0.5 - 67) years. It was determined that the obstructive hydrocephalus was caused by space-occupying lesions in nine patients (eight tumors and one with calcified arteriovenous malformation), aqueductal stenosis in 14 patients, and shunt infection and entrapped fourth ventricle in one patient. Kaplan-Meier survival analysis showed that the proportion of functioning ventriculostomies became stable at rates of 80% to 90% after the third postoperative month.

There was no statistically significant difference in the aqueductal stenosis and tumor subgroups (P=0.716). A high rate of functioning ventriculostomies was found in both subgroups: 12 of 14 in the aqueductal stenosis subgroup and eight of nine in the tumor subgroup. In cases of intraventricular tumors, in addition to ventriculostomy, biopsy was performed that successfully helped the patient management. In the present study, the procedure failed in three patients (13%). Ventriculostomy failures occurred within three months after the operation. The cases of treatment failure were one with aqueductal stenosis, one with Chiari I, and one with pineocytoma. There was no permanent morbidity after ventriculostomy in our patients.

The results indicated that ventriculostomy is an effective treatment in cases of obstructive hydrocephalus that is caused by aqueductal stenosis and space-occupying lesions. This procedure is worthy for controlling hydrocephalus without shunt and its complications. Early clinical picture after the operation plays an important role in predicting patient's outcome after endoscopic third ventriculostomy.