Abstract
Endoscopic third ventriculostomy (ETV) is an effective treatment for obstructive hydrocephalus (HCP) at the level of third or fourth ventricle. To date, there is no consensus regarding its role as intervention preceding the operation of tumour removal. The aim of this prospective open-label controlled study is to assess if ETV prevents secondary HCP after tumour removal and if ETV influences the early results of tumour surgery. The study was performed on 68 patients operated for tumours of the third ventricle and posterior fossa. In 30 patients, ETV was performed several days before tumour removal, while in 38 patients, the tumour was removed during a one-stage procedure without ETV. Patients who did not receive ETV before the tumour removal procedure had a higher probability of developing postoperative HCP (n = 12, p = 0.03). They also demonstrated a substantially higher rate of early postoperative complications (n = 20, p = 0.002) and a lower Karnofsky score (p = 0.004) than patients in whom ETV was performed before tumour removal. The performance of external ventricular drainage in the non-ETV group did not prevent secondary HCP (p = 0.68). Postoperative cerebellar swelling (p = 0.01), haematoma (p = 0.04), cerebrospinal fluid leak (p = 0.04) and neuroinfection (p = 0.04) were the main risk factors of persistent HCP. Performance of ETV before tumour removal is not only beneficial for control of acute HCP but also prevents the occurrence of secondary postoperative HCP and may also minimize early postoperative complications.
Highlights
Endoscopic third ventriculostomy (ETV) is an effective method for the treatment of obstructive hydrocephalus (HCP) at the level of the third or fourth ventricle [11, 28]
The remaining patients (n = 68), who qualified for radical tumour removal, were divided into two groups: group A—patients who underwent a two-stage treatment— ETV, followed by tumour removal; group B—only tumour removal with or without external ventricular drainage (EVD) performed during the same surgery (Fig. 1)
The main goal of this prospective open-label controlled study, performed on patients diagnosed with tumours causing non-communicating HCP, was to evaluate if ETV conducted before tumour removal was beneficial for the patients compared to the group in whom ETV was not performed
Summary
Endoscopic third ventriculostomy (ETV) is an effective method for the treatment of obstructive hydrocephalus (HCP) at the level of the third or fourth ventricle [11, 28]. The majority of studies on this topic were performed in paediatric patients and gave incoherent results, favouring its performance either before posterior fossa surgery [21] or after it, only in cases of persistent HCP [8, 16]. In adult patients with obstructive HCP caused by posterior fossa tumours, the risk of persistent HCP after tumour removal was shown to be even lower than in the paediatric population [15]. The general view was not to justify ETV in every patient with HCP and posterior fossa tumour, treatment of patients with posterior fossa tumours without ETV was accompanied by a higher rate of postoperative complications [15]. In this prospective controlled open-label study, we sought
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