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Surgical Outcome of CSF Drainage in Paediatric Obstructive Hydrocephalus
1Dr Sukriti Das, Associate Professor, Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh;
Insights
Endoscopic third ventriculostomy (ETV) offers better long-term outcomes for paediatric obstructive hydrocephalus than Ventriculo-peritoneal (VP) shunts, despite higher initial failure rates. ETV is associated with fewer infections and re-operations.
Area of Science:
- Neurosurgery
- Paediatric Medicine
- Cerebrospinal Fluid (CSF) Dynamics
Background:
- Hydrocephalus (HCP) involves CSF imbalance, leading to increased intracranial pressure, a common neurosurgical issue in children.
- Surgical CSF diversion is crucial for managing obstructive hydrocephalus.
- Endoscopic third ventriculostomy (ETV) and Ventriculo-peritoneal (VP) shunts are primary surgical interventions.
Purpose of the Study:
- To compare the surgical outcomes of ETV versus VP shunt in paediatric patients with obstructive hydrocephalus.
- To evaluate the efficacy and complications associated with each CSF diversion technique.
Main Methods:
- A prospective experimental study involving 60 paediatric patients (6 months to 18 years) with obstructive hydrocephalus.
- Patients were divided into two groups: 30 underwent ETV (Group A) and 30 underwent VP shunt (Group B).
- Surgical outcomes, including symptomatic improvement, GCS scores, and post-operative complications, were analyzed.
Main Results:
- The ETV group showed earlier symptomatic improvement and GCS score enhancement with fewer immediate complications.
- The VP shunt group demonstrated greater improvement in papilledema, occipital frontal circumference (OFC) regression, and fontanelle size at 3-month follow-up.
- ETV had higher immediate procedural failure and intraventricular hemorrhage rates, while VP shunts had higher infection and re-operation rates.
Conclusions:
- Endoscopic third ventriculostomy (ETV) is a technologically superior technique for obstructive hydrocephalus, offering better long-term results.
- ETV is associated with a lower incidence of infection and re-operation compared to VP shunts.
- While VP shunts provide more immediate physical improvements, ETV is recommended for its superior long-term efficacy and safety profile.
Abstract:
Hydrocephalus (HCP) is occurred when there is inequality in the formation and absorption of CSF to such a level which causes accumulation of fluid and causing raised intracranial pressure. Hydrocephalus is the most frequent neurosurgical problem encountered in the paediatric age group. CSF diversion surgically is needed as treatment for certain condition. Endoscopic third ventriculostomy (ETV) and Ventriculo-peritoneal shunt (VPS) are most widely used CSF diversion procedure. Therefore, this study was conducted for comparing the surgical outcome of ETV and VP shunt in obstructive hydrocephalus. This is a prospective experimental study conducted in the Department of Neurosurgery, Dhaka Medical College and Hospital (DMCH) and Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2017 to December 2019. Paediatric patients of both sex and 6 months to 18 years of age with obstructive hydrocephalus undergone endoscopic third ventriculostomy (ETV) or ventriculo-peritoneal shunt (VP shunt) were included after fulfilling inclusion and exclusion criteria. The patients divided into two groups (Group A and Group B). The Group A included 30 patients who treated by Endoscopic third ventriculostomy and the Group B include 30 patients, who was treated by Ventriculo-peritoneal shunt. Surgical outcome was analyzed in two procedures separately. In Group A (ETV group) symptomatic improvement, GCS score improves earlier and post-operative complications relatively less than Group B (VP shunt group). But in VP shunt group 3 months follow up reveals- improvement of papilledema, Occipital frontal circumference (OFC) regression and fontanelle size improvement was more than that of ETV group. This study concluded with suggesting that Endoscopic third ventriculostomy (ETV) is technologically superior surgical technique than VP shunt. Though ETV showed relatively more immediate procedural failure and intraventricular hemorrhage but long-term outcome is better and also associated with lower incidence of infection and re-operation in comparison to VP shunt.
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