Endoscopic third ventriculostomy in post traumatic hydrocephalus- Institutional experience

Abstract

Introduction: Hydrocephalus is a known sequelae in traumatic brain injury patients. It may occur early or late and presents with dementia, urinary incotinence and difficulty in walking as described by Hakim and Adams. There are two distinct types of normal pressure hydrocephalus one is idiopathic most commonly seen in the elderly age groups and the other is secondary due to a cerebro vascular accident, trauma or surgery. The idiopathic type may not respond to the CSF diversion procedure, but the secondary type which responds to CSF diversion procedure. Our study aims at exploring the option of ETV in these patients not making them shunt dependent. Materials and Methods: The patients with traumatic brain injury admitted in the dept. of neurosurgery between January 2012 and January 2018 were included into the study. Congenital hydrocephalus and secondary hydrocephalus due to spontaneous SAH and tumours were excluded. 14 patients were identified and if there was some improvement in their condition after CSF tap test were planned for endoscopic third ventriculostomy. Results: Out of the 14 patients 2 were females and the remaining 12 were males. 2 did not improve at all. 12 had some improvement out of which 3 had a failure and underwent a v-p shunt. Hence there were 5 failures out of 14 which made 35.7%. Mitchel et al and Michelangelo et al reported 72-75% success rates in their study which is similar to our results. Conclusion: ETV is an option which can be offered to patients with secondary hydrocephalus. The chances of failure though present the procedure is minimally invasive and improves CSF dynamics. Keywords: Secondary hydrocephalus due to trauma, Endoscopic third ventriculostomy, Trauma induced hydrocephalus.