Cranial growth restriction, a fundamental measure for success of the endoscopy in children under 1 month of age. Is it possible to improve the outcome?

Abstract

BackgroundEndoscopic third ventriculostomy has been shown to be efficient for the treatment of non-communicating hydrocephalus. However, it is not recommended as the first option in the treatment of obstructive hydrocephalus in children under 3months of age, because the success rate is less than 35%. MethodsWe reviewed all the cases of triventricular hydrocephalus treated between 2007 and 2011 in patients under 1month of age in the case of normal term births or under 1month of corrected age, in the case of pre-term births. The first treatment option was endoscopic fenestration and a restriction of cranial volume during the two months after surgery. ResultsTen patients under 1month of age underwent 13 ventriculostomies for non-communicating hydrocephalus of varying etiology (suprasellar arachnoid cyst (3), stenosis of the Sylvian aqueduct (2), post-infectious meningitis (3), and intrauterine bleeding (2)). Three required surgical endoscopic revision at 3, 4, and 5months, respectively, after the initial surgery due to progressive ventricular enlargement. One of these three patients presented with Klebsiella pneumoniae ventriculitis as a complication after the second endoscopy. After a mean follow-up of 32months, none has required a shunt. ConclusionsIn our limited experience in triventricular hydrocephalus in patients under 1month, the third ventriculostomy technique may be a better option than the shunt in selected cases.