Outcome of endoscopic third ventriculostomy: analysis of first 23 cases

Abstract

Background: Surgical treatment of hydrocephalus has been in the form of CSF diversion procedures since centuries. The introduction of Neuroendoscope added to the improved optics in the form of advanced lens – rod system and better illumination using xenon cold light source has provided greater impetus to Endoscopic third ventriculostomy (ETV) as a viable and effective treatment modality. Methods: This retrospective study analyses the clinical and radiological outcome of ETV in the first 23 patients of varied age groups and etiologies operated over a period of 24 months. The follow up duration ranged from 5 months to 30 months. A successful outcome was considered if there was resolution of clinical symptoms and improvement in radiological features of hydrocephalus and no requirement of alternative CSF diversion procedure (V P Shunt). A failure was indicated by either lack of clinical improvement or radiological features of partial or complete resolution of hydrocephalus and need for an alternative CSF diversion procedure (V P Shunt). Results: The predominant age group was 6-60 years. The age ranged from 1 month to 67 years. The Male: Female ratio was 14:9. The common etiologies were congenital, post infective and intracranial bleed in 26.1% (n=6) each. Favorable outcome was seen in 82.6% of cases. The failure rate was 17.4%. Most no of cases with favorable outcome was seen in 6-60 years age group, whereas >60 years age group had the most no of cases with poor outcome. The overall mortality rate was 21.6 % (n=5). Wound related complication was seen in 1 patient (4.3%). Two (8.7%) patients required VP shunt post ETV. The cause of mortality was aspiration pneumonitis in 3 cases, CSF metastasis and wound infection in 1 cases each. Conclusions: ETV is a safe viable and effective alternative for VP shunt as a CSF diversion procedure in the treatment of Hydrocephalus. It provides long lasting and virtually permanent solution due to its non-dependence on hardware and implants. Cost of equipment and availability of surgical expertise are the only impediments to this promising treatment modality.