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Indications for endoscopic third ventriculostomy in normal pressure hydrocephalus
Nikolaos Paidakakos1, S Borgarello, M Naddeo
1Department of Neurosurgery, C.T.O. Hospital, Turin, Italy. n.paidakakos@gmail.com
Acta Neurochirurgica. Supplement
|November 26, 2011
Summary
Normal pressure hydrocephalus (NPH) management is controversial. Preoperative assessment aids in selecting patients for shunt or endoscopic third ventriculostomy (ETV), with ETV showing similar efficacy and fewer complications.
Area of Science:
- Neurosurgery
- Neurology
Background:
- Normal pressure hydrocephalus (NPH) diagnosis and management remain subjects of debate.
- Current diagnostic methods and outcome prediction for NPH require refinement.
- A standardized preoperative assessment is proposed to improve patient selection and treatment stratification.
Purpose of the Study:
- To establish a preoperative assessment routine for accurately selecting NPH patients.
- To differentiate NPH patients for optimal surgical treatment, identifying potential endoscopic third ventriculostomy (ETV) responders.
- To correlate diagnostic test results with postoperative outcomes for both shunting and ETV.
Main Methods:
- Prospective study of 44 patients with suspected NPH.
- Utilized clinical symptoms, neuroradiological evidence, and supplemental diagnostic tests including tap test, external lumbar drainage, and cerebrospinal fluid outflow resistance (Rout) determination.
- Patients were treated with either shunt procedures or ETV based on individual response during infusion tests.
Main Results:
- Both shunt procedures and ETV demonstrated approximately 70% efficacy.
- Endoscopic third ventriculostomy (ETV) was associated with a significantly lower complication rate compared to shunting.
- Individual response during infusion tests guided the choice between shunt or ETV.
Conclusions:
- Cerebrospinal fluid outflow resistance (Rout) is valuable for preoperative assessment and treatment selection in NPH patients.
- In carefully selected patients, ETV offers qualitative results comparable to shunting.
- ETV presents a significantly safer alternative with fewer complications than shunting for NPH management.
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