[Endoscopic ventriculostomy in the treatment of obstructive forms of hydrocephalus]

Third ventriculostomy creating a pathway for the CSF from the third ventricle to the interpeduncular cistern is a rational and sound alternative to the implantation of the shunting system, including Torkildsen shunts in managing obstructive hydrocephalus. Twenty four patients with hydrocephalus aged from 6 to 46 (mean 21 year) were operated. In 20 patients the occlusion was caused by small tumors in the aqueduct area, in 4 cases the occlusion was due to non-neoplastic process. In the majority of cases (19 patients) third ventriculostomy was the first operation for hydrocephalus. A rigid ventriculoscope (K. Storz, Germany) with an external diameter of 6 mm was used in all procedures. In 23 patients a rapid clinical improvement was observed along with resolution of intracranial hypertension. Median follow-up of 7 months duration was possible in 18 cases. 16 patients remain stable with no signs of hydrocephalus. Control MRI studies showed patent ventriculostomy. 5 patients after an endoscopic procedure were treated with irradiation for tumors. In 2 patients the opening in the ventricular floor fused and became nonfunctional. It happened 4 months after fenestration followed by surgical removal of tumors of the pineal region which caused occlusion. Complications were observed in 2 cases. In one patient ventriculitis developed shortly after the procedure and resolved completely by the end of the second postoperative week. Another patient was noted to have signs of transitory moderate diabetes insipidus.