Abstract
Background and Objectives: Ventriculoperitoneal Shunt (VPS) and Endoscopic Third Ventriculostomy (ETV) are both gold standard procedures to reduce intracranial pressure (ICP) in patients with obstructive hydrocephalus, which often results in papilledema. This comparative study was carried out at the Department of Neurosurgery of Dhaka Medical College and Hospital to compare the efficacy of VPS and ETV in the resolution of papilledema in 18 patients with obstructive hydrocephalus. Materials and Methods: The success of CSF diversion was evaluated by a decrease in retinal nerve fiber layer (RNFL) thickness by optical coherence tomography (OCT) and modified Frisen grading of papilledema at the same time. The statistical analyses were carried out by using paired sample t test and the Spearman’s correlation coefficient test. The level of significance (p value) was set at <0.05. Results: After 7 days, both VPS and ETV were able to reduce RNFL thickness of both eyes with a p value = 0.016 (right eye) and 0.003 (left eye) in group A (VPS) and with a p value <0.001 (both eyes) in group B (ETV). Change of Frisen grading after CSF diversion was not satisfying for both the procedures with p value > 0.05. Further, the inter-group comparison between VPS and ETV showed no difference in decreasing RNFL thickness and modified Frisen grading (p value = 0.56). Conclusion: VPS and ETV procedures both appear very efficient in treating obstructive hydrocephalus, which in turn reduces papilledema in these patients. This paper is preliminary and requires further work.
Highlights
Obstructive hydrocephalus is the clinical condition characterized by enlargement of cerebral ventricles and associated symptoms caused by raised intracranial pressure (ICP)
Endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunt (VPS) are two surgical methods used for the treatment of obstructive hydrocephalus to create an alternative pathway for CSF to flow out of the ventricles and around the brain (ETV) or in the peritoneum (VPS)
Funnell et al [14] reported that patients with papilledema had higher ICP values than patients who did not develop papilledema (10.4 vs. 6.3 mmHg, respectively) and observed that Frisen grade was statistically correlated with ICP values, whereas patients with higher ICP values were more likely to develop papilledema
Summary
Obstructive hydrocephalus is the clinical condition characterized by enlargement of cerebral ventricles and associated symptoms caused by raised intracranial pressure (ICP). Different studies reported different cost-effectiveness, availability of the procedures, complications, revision and both clinical and radiological outcomes between VPS and ETV [19,20,21], at present there is no clear consensus on which procedure is better For this reason, we performed a comparative prospective study to investigate and compare the effects of VPS and ETV on the resolution of papilledema from raised ICP due to obstructive hydrocephalus and if any differences in RNFL thickness by OCT occurred between two groups. Ventriculoperitoneal Shunt (VPS) and Endoscopic Third Ventriculostomy (ETV) are both gold standard procedures to reduce intracranial pressure (ICP) in patients with obstructive hydrocephalus, which often results in papilledema.
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