Water Jet Dissection Technique for Endoscopic Third Ventriculostomy Minimises the Risk of Bleeding and Neurological Complications in Obstructive Hydrocephalus with a Thick and Opaque Third Ventricle Floor

Abstract

Background: Endoscopic third ventriculostomy (ETV) is a procedure of choice in the treatment of obstructive hydrocephalus. Neurovascular injury while perforating the ventricular floor can occur when using a conventional probe, especially in patients with a thick and opaque third ventricle floor. The water jet dissection technique can be useful in such cases to perform an initial perforation.

Patients/Material and Methods: The water jet dissection technique was used to perform ETV in 36 patients with obstructive hydrocephalus with a thick and opaque third ventricle floor over a 3-year period. A water jet was generated using a syringe connected to a 2-mm catheter.

Results: The water jet dissection technique successfully created a patent ETV stoma in 31 patients. 5 patients needed a re-operation due to a blocked stoma. There were no complications related to the procedure. An improvement in clinical function was seen in 28 (83.3%) patients at a median follow-up of 29 months.

Conclusion: The water jet dissection is a useful technique while performing ETV to prevent neurovascular injury. Our improvised technique of creating a water jet is safe, inexpensive, readily available and can be practiced at any centre performing ETV.

endoscopic third ventriculostomy - water jet dissection - obstructive hydrocephalus - tuberculous meningitis

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