Available online 26 February 2013
Publication year: 2013
Source:World Neurosurgery
Objectives Endoscopic third ventriculostomy (ETV) is a routinely utilized alternative to ventriculoperitoneal shunt (VPS) in obstructive hydrocephalus. We attempt to determine the usefulness of the surgeon's intraoperative impression and postoperative period intracranial pressure monitoring that may help guide clinicians in predicting the early functional outcome of ETV. Methods The patients who underwent ETV between 2006 and 2011 were retrospectively reviewed. The sample included sixty-three patients, 23 female and 40 male, between the ages of 13 and 69. In each case the surgeon's intraoperative impression, cerebrospinal fluid (CSF) samplings and post-operative intracranial pressure (ICP) monitoring (via transduced external ventricular drain for upto seventy-two hours) was recorded and evaluated in light of functional outcome of ETV at discharge and early follow up. (1-2 months) Results ICP monitoring predicted initial function of the ETV in 51 cases (80.9%) and in 12 cases (19%) suggested ETV failure. Monitoring has a positive predictive value (PPV) of 76.3% and a negative predictive value (NPV) of 100%. While the surgeon's intraoperative impression of future function has a PPV of 76.5%, and NPV of 76.9%. CSF sampling has a much poorer predictive quality owing to the wide confidence interval and a PPV of 63.6% and NPV 38.2%. In our series the evidence of sepsis as a result of EVD was found to be 11.67%. Subgroup analysis, removing the patients with Posterior Fossa Tumors, results in increased PPV (85.7%) of ICP monitoring. Conclusions ETV is a valuable means of treating obstructive hydrocephalus. By considering the surgeon's intraoperative impression and post-operative ICP monitoring course some of the uncertainty around its functional outcome can be overcome. The surgeon's impression and the ICP monitoring offer approximately the same predictive quality for ETV outcome.
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