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Published on: June 28, 2024
Extra-Axial Endoscopic Third Ventriculostomy (EAETV) - A Novel Remedy to Contain Persistent Cerebrospinal Fluid Leak
Sanjeev Kumar1, Vrushabh Vinay Rode1, Debabrata Sahana2
1Department of Neurosurgery, DKS Post Graduate Institute and Research Center, Raipur, Chhattisgarh, India.
Background:
The conventional methods have their limitations in containing CSF leaks after infratentorial neurosurgery.
Objective:
To test the utility of a novel method Extra-Axial ETV (EAETV), for containing persistent CSF leaks after infratentorial neurosurgery.
Methods And Material:
This prospective pilot study was conducted between April 2022 and September 2024 and included all patients who underwent intradural infratentorial neurosurgery. The recurrent cases, patients with VP shunts, patients requiring CSF diversion before the onset of CSF leak, patients requiring postoperative EVD for >48 hours, and patients who died of causes other than CSF leak were excluded.
Results And Conclusion:
The incisional CSF leak occurred in 41/274 (14.96%) cases. Patients with persistent ventriculomegaly/hydrocephalus had a significantly higher incidence of CSF leak (p-0.02). The conservative methods contained CSF leaks in 23/41 (56.1%) patients. Of 18 patients with persistent CSF leaks, ten underwent EAETV and a lumbar drain was placed in eight. The lumbar drain contained CSF leaks in six (75%) while EAETV contained CSF leaks in all cases. The EAETV diverts CSF to the supratentorial compartment and thereby reduces CSF circulation to the infratentorial compartment. This helps in containing persistent CSF leaks after infratentorial surgery. It also addresses the associated hydrocephalus.
