Publication:

Outcome of endoscopic third ventriculostomy: analysis of first 23 cases

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.