Publication year: 2012
Source: World Neurosurgery, Available online 10 February 2012
Triantafyllos Bouras, Spyros Sgouros
The treatment of choice for several types of obstructive hydrocephalus is endoscopic third ventriculostomy. However, in certain cases ETV is not clearly superior to shunt placement, and a question of choice rises. Apart from the possibility of success in each case, knowledge of complication rates is of major importance, as well.Several series of ETVs have been published by various specialized centers. Reported overall complication rate is usually between 5 and 15% and related permanent morbidity lower than 3%. The reported mortality of ETV is lower than 1%.The most frequent intra-operative complications of ETV are hemorrhage (the most severe being due to basilar rupture) and injury of neural structures. In the immediate post-operative period, hematomas, infections and CSF leaks may present. Morbidity can be neurological and/or hormonal. Systemic complications are related to the patient's general status and less to the procedure itself.Late sudden deterioration, leading as a rule to patient's death, has been reported. It's incidence is not exactly known but probably is lower than 0.1%. Nevertheless, the severity of this complication necessitates alertness and informing of the patient.In conclusion, the complication rate of ETV is low and rarely a reason of choosing shunt placement instead. However, as a method it requires considerable experience and several studies report a relation of experience not only with success rates, but with complication avoidance as well.
Júlio Leonardo B. Pereira
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