Endoscopic Third Ventriculostomy in Adults:Outcome Analysis in 140 Patients

Keywords: third ventriculostomy, outcome, hydrocephalus, third ventricle, cerebrospinal fluid

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     Ventriculo-peritoneal shunt (VPS)has been the traditional treatment of hydrocephalus (HC) in adults. ETV has the advantage of no implanted device and no risk of revisions.
     This study highlights the selection and application of ETV in adults as an alternative to VPS.
     Between 2000 and 2011 143 ETV''s were performed on 140 adult patients admitted to the Department of Neurosurgery at SUNY Buffalo. The age range (17-88), 49.3% female and 50.7 male.
     Failure was assigned to any case requiring further cerebrospinal fluid (CSF) diversion. The method of ETV at Buffalo was previously described. It is a direct endoscopic perforation of the 3rd ventricle floor with a 0 degree scope in a 4.6mm irrigating rigid sheath.
     The overall success rate was 77% (108/140). There were 3 successful redo''s.The most common causes of HC were aqueduct stenosis (success 91%), communicating hydrocephalus (success 50%), and obstruction from tumor/cyst (100%). Thirty -three ETV''s were performed on patients who were in the neurosurgical intensive care unit (NICU) at the time.Twenty-two (22/33=67%) were dependent on external ventricular drainage (EVD). ETV resulted in the successful removal of the EVD in 18 (18/22=82%). The overall complication rate was 4.8% (7/143) with 2.1% serious (3/143). No vascular injuries occurred. Six patients died within 30 days of ETV, none were related to the procedure.
     This is a retrospective study.
     HC from a variety of causes is amenable to ETV as an alternative to VPS in adults. ETV success and low complications can lead to a marked decrease in VPS in adults.
     ETV in the NICU is useful in the EVD dependent patient.


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