Endoscopic third ventriculostomy in treatment of hydrocephalus.

Endoscopic third ventriculostomy (ETV) is a minimally invasive method of treatment of obstructive hydrocephalus (HCP).

To investigate perioperative and intraoperative difficulties, failures and complications of ETV.

Seventy-three procedures of ETV were conducted in our department in the last 5 years on 69 patients with HCP of different etiology. In 4 patients we performed ETV twice. In 4 cases we used neuronavigation. In 6 cases ETV was performed in conjunction with endoscopic biopsy of the tumor. In 6 cases we had to repeat the procedure (4) or implant a ventriculo-peritoneal shunt (2) due to recurrence of symptoms.

In our series we had 3 important complications: one thalamic injury and 2 intraventricular hemorrhages. In 4 cases we observed postoperative hyperthermia with the presence of meningeal symptoms. Two cerebrospinal fluid (CSF) leaks were secured with additional stitches and 2 CSF infections were treated with antibiotics. In 1 patient epileptic seizers were observed. Three others complained of nausea and vomiting. The initial success rate of ETV is 70%.

Based on our material we conclude that ETV is a useful and helpful procedure in non-communicating HCP. It carries 4% perioperative risk of serious complications which can be reduced by proper selection of patients, detailed plan and skilful performance of surgery in experienced hands and meticulous postoperative care.