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Endoscopic third ventriculostomy for obstructive hydrocephalus in children younger than 6 months of age: is it a first-choice method?

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Abstract

Introduction

Endoscopic third ventriculostomy (ETV) is considered a safe procedure and is a method of choice in treatment of obstructive hydrocephalus nowadays. In case of Sylvian aqueduct stenosis, the success rate reaches 90%. In children younger than 6 to 24 months, respectively, however, some authors report lower effectiveness ranging between 0% and 64%. The reasons of ETV failure are discussed: hyporesorption in patients with obstruction as a consequence of hemorrhage or infection, suboptimal ETV performance, especially in premature newborns, or the theory of different cerebrospinal fluid circulation in newborn babies.

Materials and methods

Between January 2005 and December 2006 in our clinic, 14 patients younger than 6 months having presented with obstructive hydrocephalus were treated endoscopically. Obstruction was revealed by preoperative magnetic resonance imaging. The etiology of hydrocephalus was congenital aqueduct stenosis in five patients, posthemorrhagic obstruction in eight patients, and combination of posthemorrhagic and postinfection etiology in one patient. ETV was considered successful when no shunt operation was needed in the patient.

Results

ETV was successful in eight patients who experienced regression of signs of intracranial hypertension and were not forced to undergo ventriculo-peritoneal (V-P) shunting. In one patient, a successful repeat ETV was performed. In the remaining six patients, V-P shunt implantation was necessary. Total success rate in our group of patients was 57%. The only complication was subdural hygroma in one patient requiring evacuation.

Conclusion

Based on our experience, we recommend ETV as the method of choice in children younger than 6 month of age.

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Authors and Affiliations

  1. Department of Neurosurgery, University Hospital of Ostrava, 17. listopadu 1790, Ostrava-Poruba, 708 52, Czech Republic

    Radim Lipina & Štefan Reguli

  2. Department of Radiology, University Hospital of Ostrava, 17. listopadu 1790, Ostrava-Poruba, 708 52, Czech Republic

    Viera Doležilová

  3. Department of Pediatric Neurology, University Hospital of Ostrava, 17. listopadu 1790, Ostrava-Poruba, 708 52, Czech Republic

    Marie Kunčíková

  4. Department of Neonatology, University Hospital of Ostrava, 17. listopadu 1790, Ostrava-Poruba, 708 52, Czech Republic

    Hana Podešvová

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  1. Radim Lipina
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  2. Štefan Reguli
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  4. Marie Kunčíková
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Correspondence to Radim Lipina.

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Lipina, R., Reguli, Š., Doležilová, V. et al. Endoscopic third ventriculostomy for obstructive hydrocephalus in children younger than 6 months of age: is it a first-choice method?. Childs Nerv Syst 24, 1021–1027 (2008). https://doi.org/10.1007/s00381-008-0616-6

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  • DOI: https://doi.org/10.1007/s00381-008-0616-6

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