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Visual outcome after endoscopic third ventriculostomy for hydrocephalus

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Abstract

Purpose

Hydrocephalus-related symptoms are mostly improved after successful endoscopic third ventriculostomy (ETV). However, visual symptoms can be different. This study was focused on visual symptoms. We analyzed the magnetic resonance images (MRI) of the orbit and visual outcomes.

Methods

From August 2006 to November 2016, 50 patients with hydrocephalus underwent ETV. The male-to-female ratio was 33:17, and the median age was 61 years (range, 5–74 years). There were 18 pediatric and 32 adult patients. Abnormal orbital MRI findings included prominent subarachnoid space around the optic nerves and vertical tortuosity of the optic nerves. We retrospectively analyzed clinical symptoms, causes of hydrocephalus, ETV success score (ETVSS), ETV success rate, ETV complications, orbital MRI findings, and visual impairment score (VIS).

Results

The median duration of follow-up was 59 months (range, 3–113 months). The most common symptoms were headache, vomiting, and gait disturbance. Visual symptoms were found in 6 patients (12%). The most common causes of hydrocephalus were posterior fossa tumor in 13 patients, pineal tumor in 12, aqueductal stenosis in 8, thalamic malignant glioma in 7, and tectal glioma in 4. ETVSS was 70 in 3 patients, 80 in 34 patients, and 90 in 13 patients. ETV success rate was 80%. ETVSS 70 showed the trend in short-term survival compared to ETVSS 90 and 80. ETV complications included epidural hematoma requiring operation in one patient, transient hemiparesis in two patients, and infection in two patients. Preoperative abnormal orbital MRI findings were found in 18 patients and postoperative findings in 7 patients. Four of six patients with visual symptoms had abnormal MR findings. Three patients did not show VIS improvement, including two with severe visual symptoms.

Conclusions

Patients with severe visual impairment were found to have bad outcomes. The visual symptoms related with increased intracranial pressure should be carefully monitored and controlled to improve outcomes.

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Acknowledgements

This study was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF), funded by the Ministry of Science, ICT, & Future Planning (2017R1A1A1A05001020).

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Authors and Affiliations

  1. Department of Neurosurgery, Chonnam National University Hwasun Hospital & Medical School, 322, Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeollanam-do, 519-763, Republic of Korea

    Ji-Ho Jung, Yong-Hyun Chai, Shin Jung, In-Young Kim, Woo-Youl Jang, Kyung-Sub Moon & Tae-Young Jung

  2. Department of Radiology, Chonnam National University Hwasun Hospital & Medical School, 322, Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeollanam-do, 519-763, Republic of Korea

    Seul-Kee Kim

  3. Division of Pediatric Neurosurgery, Seoul National University Children’s Hospital, Seoul, South Korea

    Sangjoon Chong & Seung-Ki Kim

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  1. Ji-Ho Jung
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  2. Yong-Hyun Chai
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  3. Shin Jung
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Correspondence to Tae-Young Jung.

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Jung, JH., Chai, YH., Jung, S. et al. Visual outcome after endoscopic third ventriculostomy for hydrocephalus. Childs Nerv Syst 34, 247–255 (2018). https://doi.org/10.1007/s00381-017-3626-4

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  • DOI: https://doi.org/10.1007/s00381-017-3626-4

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