Abstract
Hydrocephalus is a major cause of patient decreased quality of life and high health
care financial burden in the United States and throughout the world. The placement
of ventricular shunts (ventriculoperitoneal shunt) has proven to be a safe treatment
for hydrocephalus, but it is associated with a high complication rate leading to a
lower quality of life and continued financial burden for patients, their families,
and society as a whole. The endoscopically assisted third ventriculostomy (ETV) has
been practiced as an alternative to ventricular shunting since the 1990s. Success
rates vary widely and there are many factors which contribute to the varying success
rates. The ETV procedure has the potential to alleviate much of the overall quality
of life issues and some of the financial burdens associated with hydrocephalus provided
success rates can be increased and the procedure and management techniques are adopted
more widely. Common techniques have been published in the past which report associated
improvements in success rates amongst individual surgeons. Here, we report a novel
perioperative technique and management strategy that displays a higher than reported
success rate. Our methods and results show potential to significantly improve overall
ETV success rates if reproduced and subsequently adopted widely. We retrospectively
studied records of 24 adult patients with hydrocephalus who were treated with an ETV
procedure. Routinely, we placed an external lumbar drain postoperatively which was
continued for a minimum of 2 days. There was a 95.8% success rate at 30 days. The
overall success rate was 83.3%. This is significantly higher than the average of the
predicted success scores calculated by the ETV success scoring system (71.8%). It
is also significantly higher than previous studies' reported ETV success rates in
adults. We propose additional similar studies to be performed to test the reproducibility
of increased success rates using our technique, ideally through a prospective, randomized,
multicenter trial.
Keywords
endoscopically assisted third ventriculostomy - lumbar drain - hydrocephalus - ventriculoperitoneal
shunt - ventricular shunt - ventricle - cerebrospinal fluid - brain tumor - hemorrhagic
stroke - cerebral hemorrhage - neurocysticercosis
