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Acta Neurochirurgica

, Volume 161, Issue 7, pp 1353–1360 | Cite as

Is endoscopic third ventriculostomy safe and efficient in the treatment of obstructive chronic hydrocephalus in adults? A prospective clinical and MRI study

  • Marc BaronciniEmail author
  • Gregory Kuchcinski
  • Vianney Le Thuc
  • Philippe Bourgeois
  • Henri Arthur Leroy
  • Guillaume Baille
  • Thibaud Lebouvier
  • Luc Defebvre
Original Article - CSF Circulation
Part of the following topical collections:
  1. CSF Circulation

Abstract

Background

In case of suspected normal pressure hydrocephalus, MRI is performed systematically and can sometimes highlight an obstruction of the flow pathways of the CSF (aqueductal stenosis or other downstream obstruction). It seems legitimate for these patients to ask the question of a treatment with endoscopic third ventriculostomy (ETV), even if the late decompensation of an obstruction may suggest an association with a CSF resorption disorder. The aim of this study was to evaluate clinical and radiological evolution after ETV in a group of elderly patients with an obstructive chronic hydrocephalus (OCH).

Methods

ETV was performed in 15 patients with OCH between 2012 and 2017. Morphometric (callosal angle, ventricular surface, third ventricular width, and Evans’ index) and velocimetric parameters (stroke volume of the aqueductal (SVa) CSF) parameters were measured prior and after surgery with brain MRI. The clinical score (mini-mental status examination (MMSE) and the modified Larsson’s score, evaluating walking, autonomy, and incontinence) were performed pre- and postoperatively.

Results

SVa was less than 15 μL/R-R in 12 out of the 15 patients; in the other three cases, the obstruction was located at a distance from the middle part of the aqueduct. Fourteen out of 15 patients were significantly improved: mean Larsson’s score decreased from 3.8 to 0.6 (P ≤ 0.01) and mean MMSE increased from 25.7 to 28 (P = 0.084). Evans’ index and ventricular area decreased postoperatively and the callosal angle increased (P ≤ 0.01). The mean follow-up lasted 17.9 months. No postoperative complications were observed.

Conclusion

ETV seems to be a safe and efficient alternative to shunt for chronic hydrocephalus with obstruction; the clinical improvement is usual and ventricular size decreases slightly.

Keywords

Ventriculostomy Normal pressure hydrocephalus Chronic hydrocephalus Aqueductal stenosis Endoscopy Third ventricle MRI 

Notes

Acknowledgements

We thank Ingrid Bouvier, for proofreading the document in English.

Funding

This study received financial support in the form of the interregional clinical research hospital program (IR11) funding.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (ethics committee of the Amiens University Hospital where the full study protocol can be accessed: n° ID RCB: 2011-A01633-38) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Neurosurgery, Lille University Hospital (CHU Lille)University of LilleLilleFrance
  2. 2.Department of Neuroradiology, Lille University Hospital (CHU Lille)University of LilleLilleFrance
  3. 3.Department of Neurology, Lille University Hospital (CHU Lille)University of LilleLilleFrance

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