Endoscopic third ventriculostomy

Abstract

Third ventriculostomy has been used for the treatment of obstructive hydrocephalus since Dandy first performed such operation in 1922. With the development of fiberopic technology and new endoscopic equipments, neuroendoscopic procedure has become one of the highlights of recent advance in neurosurgery. The author has performed endoscopic third ventriculostomies in 26 patients suffering from obstructive hydrocephalus since 1989. The most common cause of obstructive hydrocephalus in those patients was aqueductal stenosis. Twenty of the 26 patients were treated by endoscopic third ventriculostomy only, and 16 of the cases(i. e., 80%) were successful without the need of shunting operation. However, the remaining 4 cases required ventriculopritoneal shunt. Six patients, who were either under the age of one year old or had previous multiple shunts, received endoscopic third ventriculotomy and ventriculopritoneal shunt simultaneously. The 10 patients(out of the original group of 26) who received both endoscopy and shunt, required no shunt revision during the follow-up periods of 6 months to 4 years. Of all the cases, while no mortalities occurred, we had encountered 3 complications which consists of 2 transients diabetes insipidus and 1 postoperative epidural hematoma around a burr hole site. The authors therefore concludes that endoscopic third ventriculostomy is a simple and effective procedure for the treatment of obstructive hydrocephalus. Equipment, procedure, pre and post operative workup and results were fully discussed with literature review.