Endoscopic third ventriculostomy: towards more indications for the treatment of non-communicating hydrocephalus.

Abstract

Since its reintroduction during the last 2 decades, third ventriculostomy has shown promising results. However, with more experience and better selection of cases, the indications and contraindications are likely to change. During the period from November 1994 to December 1996, we have treated 27 patients with non-communicating hydrocephalus by endoscopic third ventriculostomy at the King Khalid University Hospital. Their ages ranged from 35 weeks preterm to 26 years of age. Sixteen (59%) patients were one year old or younger. Their follow-up ranged from 9 months to 2.5 years. According to the etiology of the non-communicating hydrocephalus, patients were divided into 4 subgroups. These were as follows: 11 aqueduct stenosis, 6 post ventriculitis, 6 cysts, and 4 posterior fossa tumours. The outcome was graded into 3 grades: Grade III were patients who improved after the procedure. Grade II were patients who improved after adding a VP-shunt to the procedure. Grade I were failure patients. An overall outcome of Grade III was achieved in 22 patients (81%). This was broken down according to subgroups as follows: 8/11 (73%) patients of subgroup 1, 5/6 in each of the patients of subgroup 2 and 3, and all of the patients with posterior fossa tumours. The overall results were very encouraging and so for the subgroups as compared with the reported cases in the literature. Better selection of the cases and increased experience with the procedure is expected to improve the outcome.