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Endoscopic third ventriculostomy in the management of obstructive hydrocephalus: Success and failure.


Article Information

Title: Endoscopic third ventriculostomy in the management of obstructive hydrocephalus: Success and failure.

Authors: Sohail Amir, Shahid Ayub

Journal: The Professional Medical Journal (TPMJ)

HEC Recognition History
Category From To
Y 2024-10-01 2025-12-31
Y 2023-07-01 2024-09-30
Y 2022-07-01 2023-06-30
Y 2021-07-01 2022-06-30

Publisher: Independent Medical College, Faisalabad- Pakistan

Country: Pakistan

Year: 2022

Volume: 29

Issue: 8

Language: English

DOI: 10.29309/TPMJ/2022.29.08.6745

Keywords: ComplicationEndoscopic Third VentriculostomyObstructive Hydrocephalus

Categories

Abstract

Objective: To determine if endoscopic third ventriculostomy (ETV) is effective in the treatment of obstructive hydrocephalus. Study Design: Prospective study.  Setting: Department of Neurosurgery, Hayatabad Medical Complex, Peshawar. Period: February 2018 to March 2021. Material & Methods: Eighty Five patients underwent endoscopic third ventriculostomy (ETV) for obstructive hydrocephalus all patients with obstructive hydrocephalus of any gender and age more than 6 months were included in the study.  Patients age less than 6 months, recurrent cases and those refuse to opt for ETV were excluded from our study. The information regarding patient demographic, etiology, complications of procedure were documented in proforma. Data was analyzed using SPSS version 20.0 and presented in form of tables. Results: In the current study out of 85 patients, 48(56.4%) were male and 37(43.5%) were females with male to female ratio=1.23. ETV had successful outcome in 66(77.6%) patients. The sign and symptoms of raised intracranial pressure resolved in all patients after ETV. Overall complication rate in our study was 22(25.8%). The commonest complication was inadequate ventriculostomy in 10(11.7%), per operative significant bleeding in 4(4.7%) of patient, seizure in 3(3.5%) of patients, CSF leak and intraventricular hemorrhage in 2(2.35%) respectively. Conclusion: ETV is minimally invasive, safe, effective mode of treatment for obstructive hydrocephalus. Success rate is higher in children below 5 years of age. The overall success rate varies from 70-80% in various studies.


Research Objective

To determine if endoscopic third ventriculostomy (ETV) is effective in the treatment of obstructive hydrocephalus.


Methodology

Prospective study conducted in the Department of Neurosurgery, Hayatabad Medical Complex, Peshawar, from February 2018 to March 2021. Eighty-five patients with obstructive hydrocephalus (age > 6 months) underwent ETV. Patients younger than 6 months, recurrent cases, and those who refused ETV were excluded. Data on demographics, etiology, and complications were collected and analyzed using SPSS version 20.0.

Methodology Flowchart
                        graph TD
    A["Patient Recruitment Obstructive Hydrocephalus, Age > 6 months"] --> B["ETV Procedure"];
    B --> C["Data Collection Demographics, Etiology, Complications"];
    C --> D["Data Analysis SPSS v20.0"];
    D --> E["Outcome Assessment Success/Failure, Complications"];
    E --> F["Conclusion and Discussion"];                    

Discussion

ETV is presented as a minimally invasive, safe, and effective treatment for obstructive hydrocephalus. The study's findings on etiology (posterior fossa tumors and aqueductal stenosis being most common) and success rates align with existing literature. Complications, though present, are considered manageable with proper patient selection, surgical skill, and post-operative care.


Key Findings

ETV was successful in 66 out of 85 patients (77.6%). Signs and symptoms of raised intracranial pressure resolved in all patients post-ETV. The overall complication rate was 25.8%, with the most common being inadequate ventriculostomy (11.7%), followed by per-operative bleeding (4.7%), seizures (3.5%), CSF leak (2.35%), and intraventricular hemorrhage (2.35%). Success rates were higher in children below 5 years of age.


Conclusion

Endoscopic third ventriculostomy is a safe and effective treatment for obstructive hydrocephalus, with a high success rate, particularly in younger children. Complications can be minimized through careful patient selection, skilled surgical execution, and meticulous post-operative management.


Fact Check

1. Study Period: The study was conducted over a period of three years, from February 2018 to March 2021. (Confirmed)
2. Total Patients: Eighty-five patients underwent endoscopic third ventriculostomy. (Confirmed)
3. Success Rate: ETV had a successful outcome in 66 (77.6%) patients. (Confirmed)


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