Abstract
Background; High incidence of congenital hydrocephalus will become a big problem for the family, and even the nation. The standard management is liquoral shunnting with implantation of various V-p Shunt devices. The complication relatively high beside high cost. Endoscopic third ventriculostomy(ETV) is considered to be superior to V-P Shunt.Method: All of the Obtructive hydrocephalus admitted to Sanglah Hospital between 2005 until 2016 who treated by ETV were analyzed the method of how we do it.Result: The most important is patient selection, than trajectory with rigid endoscope, identify the foramen of Monroe by following choroidal flexus, identify infundibular recess, mammillary body, locate the fenestration of base of the third ventricle safely by monopolar cauther, dilated the fenestration by Fogarty catheter F3/F4, fenestration of Liliquist membrane, and last is closing and suturing the dura and skin water tightly. Conclusion: ETV is the simple procedure for hydrocephalus lower cost compares to V-p Shunt and high successful rate, and low risk of complication, V-p shunt just for those patients who does not response to ETV.
Highlights
The incidence of congenital hydrocephalus is around 2 cases per 1000 live births
Endoscopic Third Ventriculostomy (ETV) showed its superiority compared to ventricular shunting, by avoiding shunt-related complications.[2,4,5,19,20]
Applications of currently developed Endoscopic third ventriculostomy (ETV) techniques are very broad nowadays. They includes obstructive hydrocephalus due to aqueduct stenosis, hydrocephalus with myelomeningocele, hydrocephalus associated with Dandy-Walker malformation, communicating hydrocephalus, normal pressure hydrocephalus, hydrocephalus secondary from intracranial hematoma, secondary hydrocephalus due to posterior fossa tumors, hydrocephalus after shunt malfunctions, hydrocephalus associated with fasiocraniosonostosis, hydrocephalus in patients with tuberculous meningitis and combination of the Choroid Plexus Cauterization (CPC) with ETV.[7,9]
Summary
The incidence of congenital hydrocephalus is around 2 cases per 1000 live births. Implantation of ventricular shunt systems such as VP shunt and ventriculoatrial shunt is the conventional therapy for hydrocephalus. It has several possible complications such as over or underdrainage, shunt malfunctions, and infections.[2] Complications could not entirely be prevented. Complications occur only in those who work on the first 100 cases of the procedure. The possibility of complications is minimal so that ETV is currently the first-choice therapy for obstructive hydrocephalus.[2,4,5,16] This article was based on our personal experiences in treating 184 hydrocephalus patients using ETV
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