ENDOSCOPIC VENTRICULOCISTERNOSTOMY IN TEATMENT OF OCCLUSIVE HYDROCEPHALUS

A. Melikyan

Burdenko Research Institute of Neurosurgery

Endoscopic ventriculocisternostomy is a direct alternative to conventional shunts in the majority of patients with occlusive hydrocephalus. Results of treatment of acquired forms of obstructive hydrocephalus obtained in a consecutive series of 58 patients are described. All the patients operated at the Institute in 1995-1999 had the so-called triventriculomegaly with widening of the third and both lateral ventricles. Signs of an increased intracranial pressure were watched in the majority of cases. Occlusion in 50 patients was conditioned by a tumor which was located more often in pineal or midbrain areas; there was a roentgenologic picture of “benign” stenosis of the aqueduct in 8 cases.

The age of patients varied from 3 up to 58 years (22 years on the average).

The endoscopic procedure replaced the second operation in 14 shunt-dependent patients with an incompetent or infected shunting system. Endoscopic ventriculocisternostomy was the first operation performed in the rest of patients after treatment of hydrocephalus.

Asymptomatic intraventricular bleeding was observed in 1 patient after an endoscopic operation. Moderate and transient manifestations of diabetes insipidus and bulimia were typical of 3 cases. Ventriculitis which passed without any consequences was watched in 3 patients. There were no fatal outcomes.

Healing of ventriculostoma was observed in 3 cases who underwent removal of tumor some time later after the endoscopic operation. They demanded shunt implantation. The shunt was also used in 3 other patients as there was no regress of symptoms of intracranial hypertension despite functioning ventriculostoma. The endoscopic operation resulted in stable regress of symptoms in 52 cases and, thus, a quota of successful operations was equal to 89.5% (an average period of catamnestic follow-up - 9 months).

The obtained results do not contradict data of literature and experience of other surgeons. Complications after conventional shunting operations are watched more often (35-40%) and become a frequent cause of revisions sometimes performed more than once. That is why endoscopic ventriculocisternostomy is an operation of choice in acquired occlusion in the areas of the aqueduct and posterior cranial fossa. It is expedient to use endoscopic technology and a team of surgeons-experts possessing this method in large neurosurgical hospitals.