The surgical results of endoscopic third ventriculostomy in long-standing overt ventriculomegaly in adults with papilledema

Abstract

ObjectiveLongstanding overt vetriculomegaly in adults (LOVA) is a type of chronic hydrocephalus presumed to begin during infancy, which manifests in adults after a long and slow clinical course. Only a quite small number of LOVA case series have been published, controversies regarding optimal management still exist. The authors describe a series of symptomatic LOVA patients with papilledema treated successfully using endoscopic third ventriculostomy (ETV) at a single institution. Patients and methodsIn the past 7 years, 4 LOVA patients with papilledema were surgically treated using ETV. Clinical features and neuroimaging of all patients were carefully reviewed retrospectively. Changes of the third ventricle transverse diameter, Evan’s ratio, frontal occipital horn ratio after operation were measured. ResultThere were two males and two females, with a mean age of 24 (21–29) on first presentation. Presentation symptoms were visual problems (4 cases), headaches (3 cases), hemidysesthesia(1 case), and poor mobility(1 cases). Papilledema and increased intracranial pressure were identified in all 4 cases. The mean follow-up period of this series was 5 years (range 4–6 years). All patients reported improved vision function 3 months and experienced other symptom relief accompanying with normalized intracranial pressure after ETV and did not require any further surgical intervention. ConclusionsEndoscopic third ventriculostomy provides an effective treatment for LOVA patients with papilledema, which can improve the symptoms of LOVA and relive papilledema. The fundoscopy is of great value in making decisions related to surgical intervention for LOVA patients.