Publication year: 2012
Source: World Neurosurgery, Available online 10 February 2012
Pietro Spennato, Sanna Tazi, Olivier Bekaert, Giuseppe Cinalli, Philippe Decq
BackgroundIdiopathic aqueductal stenosis is a cause of non communicating hydrocephalus which actual treatment by Endoscopic third ventriculostomy (ETV) could be assess without any interference with the etiology. The results of ETV in this indication could be therefore interpret as the results of the surgical procedure alone, without any additional factors related to the etiology of the CSF pathways obstruction like haemorrhage, infection, brain malformations and brain tumors or cysts.MethodsFollowing a brief description of pathogenesis of hydrocephalus in aqueductal stenosis, the authors review the literature for studies on ETV, extrapolating patients with idiopathic aqueductal stenosis in infancy, childhood and adulthood. Differences in outcome between patients treated with ETV and patients treated with ventriculo-peritoneal shunt (VPS) are also reviewed.ResultsThe overall success rates of ETV ranges between 23% to 94% , with a mean of 68%; when only patients affected by obstructive tri-ventricular hydrocephalus secondary to aqueductal stenosis are considered, the success rate is actually quite homogeneous and stable, being above 60% at any age, even if a trend in lower success rate in very young infant (under 6 months of age) is noticeable. The few reports on intellectual outcome failed to demonstrate differences between ETV and VPS.ConclusionSeveral issues, such as the cause of failures in well selected patients, long term outcome in infant treated with ETV, effect of persistent ventriculomegaly on neuropsychological developmental, remain unanswered. Larger and more detailed studies are needed.
Source: World Neurosurgery, Available online 10 February 2012
Pietro Spennato, Sanna Tazi, Olivier Bekaert, Giuseppe Cinalli, Philippe Decq
BackgroundIdiopathic aqueductal stenosis is a cause of non communicating hydrocephalus which actual treatment by Endoscopic third ventriculostomy (ETV) could be assess without any interference with the etiology. The results of ETV in this indication could be therefore interpret as the results of the surgical procedure alone, without any additional factors related to the etiology of the CSF pathways obstruction like haemorrhage, infection, brain malformations and brain tumors or cysts.MethodsFollowing a brief description of pathogenesis of hydrocephalus in aqueductal stenosis, the authors review the literature for studies on ETV, extrapolating patients with idiopathic aqueductal stenosis in infancy, childhood and adulthood. Differences in outcome between patients treated with ETV and patients treated with ventriculo-peritoneal shunt (VPS) are also reviewed.ResultsThe overall success rates of ETV ranges between 23% to 94% , with a mean of 68%; when only patients affected by obstructive tri-ventricular hydrocephalus secondary to aqueductal stenosis are considered, the success rate is actually quite homogeneous and stable, being above 60% at any age, even if a trend in lower success rate in very young infant (under 6 months of age) is noticeable. The few reports on intellectual outcome failed to demonstrate differences between ETV and VPS.ConclusionSeveral issues, such as the cause of failures in well selected patients, long term outcome in infant treated with ETV, effect of persistent ventriculomegaly on neuropsychological developmental, remain unanswered. Larger and more detailed studies are needed.
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