Endoscopic third ventriculostomy for obstructive hydrocephalus due to intracranial hemorrhage with intraventricular extension.

Object Endoscopic third ventriculostomy (ETV) is well accepted for obstructive hydrocephalus of various etiologies. Nevertheless, it is seldom considered in intracranial hemorrhage even in cases involving obstruction of the CSF circulation. Methods Between May 1993 and April 2008, 34 endoscopic procedures were performed for hemorrhage-related obstructive hydrocephalus with an intraventricular component. All patients were prospectively followed up. Special attention was paid to presurgical clinical status, type of hemorrhage, type of surgery, postsurgical clinical status, postsurgical ventricular size, and necessity of ventriculoperitoneal shunt implantation. Results An ETV was performed for treatment of obstructive hydrocephalus due to intracranial hemorrhage in 34 patients (15 male, 19 female; mean age 60.8 years [range 3 months-83 years]). Hydrocephalus was caused by 17 cerebellar, 6 thalamic, 5 intraventricular, 3 basal ganglia, 2 subarachnoid, and 1 pontine hemorrhage. Thirty-three patients (97.1%) presented with impaired consciousness. Intraventricular blood was present in all cases. In 16 cases (47.1%), blood clots had to be evacuated to achieve access to the third ventricle floor. The mean operation time was 58.2 minutes (range 25-120 minutes). Three complications occurred (rate of 8.8%) with 2 being asymptomatic (5.9%) and 1 being transient (2.9%). There was no procedure-related permanent morbidity, and no procedure-related mortality. After surgery, there was clinical improvement in 17 cases (50.0%) and radiological evidence of improvement in 22 cases (64.7%). Two patients required postoperative ventriculoperitoneal shunting (5.9%). Seven patients died of hemorrhage while in the hospital (20.6%), and another 4 died during follow-up (11.8%). Fifteen patients (44.1%) showed a persistent clinical improvement at the final follow-up (mean 12.2 months after surgery). Conclusions Endoscopic third ventriculostomy represents a safe treatment option in intraventricular hemorrhage-related obstructive hydrocephalus yielding similar results as an external drainage but with less risk of infection and a very low subsequent shunt placement rate. In cases with a predominant obstructive component, ETV should be considered in hydrocephalus due to intracerebral hemorrhage. However, performing an ETV with a blurred field of vision and distorted ventricular anatomy is a challenge for any endoscopic neurosurgeon and should be reserved for experienced neuroendoscopists.

[1]  H. Schroeder,et al.  Endoscopic cystoventriculostomy for treatment of paraxial arachnoid cysts. , 2009, Journal of neurosurgery.

[2]  H. Schroeder,et al.  Endoscopic options in children: experience with 134 procedures. , 2009, Journal of neurosurgery. Pediatrics.

[3]  J. Oertel,et al.  Endoscopic third ventriculostomy in obstructive hydrocephalus due to giant basilar artery aneurysm. , 2009, Journal of neurosurgery.

[4]  M. Gaab Endoneurosonography: Technique and Equipment, Anatomy and Imaging, and Clinical Application. , 2008, Neurosurgery.

[5]  J. Krauss,et al.  Ultrasonic aspiration in neuroendoscopy: first results with a new tool. , 2008, Journal of neurosurgery.

[6]  H. Schroeder,et al.  ENDOSCOPIC TREATMENT OF CEREBROSPINAL FLUID PATHWAY OBSTRUCTIONS , 2007, Neurosurgery.

[7]  D. Cho,et al.  Endoscopic surgery for thalamic hemorrhage: a technical note. , 2007, Surgical neurology.

[8]  S. Waga,et al.  Delayed Endoscopic Intraventricular Hemorrhage (IVH) Removal and Endoscopic Third Ventriculostomy May Not Prevent Consecutive Communicating Hydrocephalus if IVH Removal was Insufficient , 2007, Minimally invasive neurosurgery : MIN.

[9]  Xin-gang Li,et al.  Application of Neuroendoscopy in the Treatment of Intraventricular Hemorrhage , 2007, Cerebrovascular Diseases.

[10]  J. Krauss,et al.  The use of waterjet dissection in endoscopic neurosurgery. Technical note. , 2006, Journal of neurosurgery.

[11]  H. Schroeder,et al.  Endoscopic Third Ventriculostomy for Occlusive Hydrocephalus Caused by Cerebellar Infarction , 2006, Neurosurgery.

[12]  H. Schroeder,et al.  Third Ventriculostomy for Treatment of Hydrocephalus: Results of 271 Procedures , 2006 .

[13]  J. Otero,et al.  Management of 50 spontaneous cerebellar haemorrhages , 1993, Acta Neurochirurgica.

[14]  T. Merchant,et al.  The effects of hydrocephalus on intelligence quotient in children with localized infratentorial ependymoma before and after focal radiation therapy. , 2004, Journal of neurosurgery.

[15]  Paul Park,et al.  Risk of Infection with Prolonged Ventricular Catheterization , 2004, Neurosurgery.

[16]  P. Kan,et al.  Complications of intracranial pressure monitoring in children with head trauma. , 2004, Journal of neurosurgery.

[17]  H. Schroeder,et al.  Endoscopic aqueductoplasty in the treatment of aqueductal stenosis , 2004, Child's Nervous System.

[18]  E. de Divitiis,et al.  Endoscopic Third Ventriculostomy in Idiopathic Normal Pressure Hydrocephalus , 2004, Neurosurgery.

[19]  T. Beems,et al.  Long-term complications and definition of failure of neuroendoscopic procedures , 2004, Child's Nervous System.

[20]  H. Schroeder,et al.  Incidence of complications in neuroendoscopic surgery , 2004, Child's Nervous System.

[21]  N. Hopf,et al.  The Role of Third Ventriculostomy in the Management of Obstructive Hydrocephalus , 2003, Minimally invasive neurosurgery : MIN.

[22]  N. Bruder,et al.  [Endoscopic third ventriculostomy for management of obstructive hydrocephalus secondary to supratentorial intraventricular hematoma. Case report]. , 2002, Neuro-Chirurgie.

[23]  H. Weiner,et al.  Endoscopic third ventriculostomy in patients with cerebrospinal fluid infection and/or hemorrhage. , 2002, Journal of neurosurgery.

[24]  H. Schroeder,et al.  Complications of endoscopic third ventriculostomy. , 2002, Journal of neurosurgery.

[25]  F. Roux,et al.  Third Ventriculocisternostomy in Cerebellar Haematomas , 2002, Acta Neurochirurgica.

[26]  W. Maixner,et al.  Management of hydrocephalus in pediatric patients with posterior fossa tumors: the role of endoscopic third ventriculostomy. , 1999, Journal of neurosurgery.

[27]  J U Choi,et al.  Endoscopic surgery for obstructive hydrocephalus. , 1999, Yonsei medical journal.

[28]  M. Gangemi,et al.  Endoscopic Third Ventriculostomy for Hydrocephalus , 1999, Minimally invasive neurosurgery : MIN.

[29]  Alan R. Cohen,et al.  Endoscopic Third Ventriculostomy: Outcome Analysis of 100 Consecutive Procedures , 1999 .

[30]  K. Holloway,et al.  Ventriculostomy infections: the effect of monitoring duration and catheter exchange in 584 patients. , 1996, Journal of neurosurgery.

[31]  Kazuyoshi Watanabe,et al.  Classification of hydrocephalus and outcome of treatment , 1995, Brain and Development.

[32]  A. Cohen Endoscopic ventricular surgery. , 1993, Pediatric neurosurgery.

[33]  M. Brydon,et al.  Endoscopic third ventriculostomy. , 1990, Neurosurgery.

[34]  H. Shenkin,et al.  CEREBELLAR STROKES: MORTALITY, SURGICAL INDICATIONS, AND RESULTS OF VENTRICULAR DRAINAGE , 1982, The Lancet.

[35]  C. Lowy Diabetes and hypertension. , 1978, Lancet.

[36]  W. Dandy,et al.  AN EXPERIMENTAL AND CLINICAL STUDY OF INTERNAL HYDROCEPHALUS , 1913 .