Endoscopic third ventriculostomy in patients with a diminished prepontine interval

Area of Science:

• Neurosurgery
• Pediatric Neurosurgery
• Medical Imaging

Background:

• Endoscopic third ventriculostomy (ETV) is a key treatment for noncommunicating hydrocephalus.
• A generous prepontine interval (PPI) is considered important for ETV safety and efficacy.
• The impact of a diminished PPI on ETV outcomes has been unclear.

Purpose of the Study:

• To assess the safety and success of ETV in patients with a reduced or obliterated prepontine interval (PPI).
• To determine if a narrow PPI affects the technical or functional outcomes of ETV.

Main Methods:

• Retrospective review of 100 consecutive ETV procedures.
• Measurement of the PPI from preoperative MR imaging (distance between dorsum sellae and basilar artery).
• Analysis of technical and functional success rates for patients with PPI ≤1 mm.

Main Results:

• The PPI varied from 0 to 9.5 mm (mean 3.2 mm).
• Fifteen patients had a PPI of ≤1 mm; all underwent successful fenestration without morbidity or vascular injury.
• Functional success was achieved in 11 of these 15 patients (73.3%).

Conclusions:

• ETV can be performed safely in patients with an obliterated or reduced PPI.
• The functional success rate in this cohort appears comparable to historical data.
• Younger age at the time of ETV, rather than PPI, may be a significant factor in procedure failure.