Endoscopic third ventriculostomy in the presence of large or giant basilar artery aneurysms

Abstract

Endoscopic third ventriculostomy (ETV) is an effective treatment of obstructive hydrocephalus (OH). However, the presence of a large or giant basilar aneurysm is generally considered a contra-indication to ETV for treating hydrocephalus. We report the feasibility and efficacy of ETV for the treatment of hydrocephalus in the presence of such aneurysms. We performed a retrospective chart analysis of patients that underwent ETV for large or giant basilar aneurysm-associated hydrocephalus between January 2003 and January 2011. During this period, 78 patients were treated by ETV. Of these, three patients presented with symptomatic hydrocephalus associated with a large giant basilar aneurysm (n = 3). Two of those patients had a history of previous subarachnoid hemorrhage (SAH) with intraventricular hemorrhage (IVH) 11 years and 13 years before ETV. Both aneurysms were embolized preoperatively. The third patient presented with OH due to an unruptured basilar artery aneurysm. There was no operative complication and symptoms resolution was observed in all patients at last follow-up. ETV is a safe and effective alternative to ventriculo-peritoneal shunting in patients with hydrocephalus caused by large or giant basilar artery aneurysms. In addition, a history of SAH/IVH should not be considered a contra-indication to ETV.