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On-line version ISSN 1678-4227
Arq. Neuro-Psiquiatr. vol.56 n.2 São Paulo June 1998
ENDOSCOPIC THIRD VENTRICULOSTOMY IN THE TREATMENT OF NON-COMMUNICATING HYDROCEPHALUS (ABSTRACT)*. THESIS. RECIFE, 1997.
HILDO ROCHA CIRNE DE AZEVEDO FILHO**
Hydrocephalus is cause of raised intracranial pressure, neurological dysfunction and eventually death. The employment of shunts to control the hydrocephalic process, in use for forty years and despite marked technical improvement, is undoubtly associated with infectious and mechanical complications.
Endoscopic third ventriculostomy is proposed, as a therapeutic alternative, to patients with non-communicating hydrocephalus.
Seventy one patients were operated upon by the author using this technique. According to the aetiology of the non-communicating hydrocephalus the patients were divided into four groups: Group A (tumoural) 34 (47.8%) patients; Group B (cerebral aqueduct stenosis) 19 (26.8%) patients; Group C (associated with myelomeningocele) four (5.6%) patients; and Group D (post-meningitis and post-intracranial haemorrhage) 14 (19.7%) patients.
The endoscopic technique was successful on controlling the raised intracranial pressure in 50 (70.4%) patients; on the other hand, the method was uneffective in 21 (29.6%) patients.
The successful rates were 88.2% for patients in Group A; 78.9% for patients in Group B; 25% for patients in Group C; and 28.5% for patients in Group D. In none of the 15 patients with age under one year, the method was successful. Ventriculo-peritoneal shunts were employed on 17 of the 21 patients who had an unfavourable response to the endoscopic treatment.
One (1.4%) patient has died of cause directly related to the method, although three (4.2%) patients have died of causes undirectly related to the method. CSF leak through the surgical wound was detected on nine (12.7%) patients and raised significantly the risk of meningitis verified on four (5.6%) patients.
The findings of ventriculomegaly reduction, the openning of the floor of the third ventricle and CSF flow through the fenestration observed on the post-operative MRI were significantly related to the effectiveness of the method.
KEY WORDS: non-communicating hydrocephalus, endoscopic third ventriculostomy.
*Terceiro ventriculostomia endoscópica no tratamento das hidrocefalias não-comunicantes (Resumo). Tese de Doutorado, Centro de Ciências da Saúde da Universidade Federal de Pernambuco (Área: Neurocirurgia). Orientador: Miguel Z. Doherty.
**Address: Rua Apipucos 317 / 601, 52071-000 Recife PE, Brasil.