Early surgical outcome of endoscopic third ventriculostomy in the management of obstructive hydrocephalus: A randomized control trial

Abstract

Background:Management of obstructive hydrocephalus is an important issue for the reduction of mortality and morbidity.Objectives:The aim of the present study was to assess the early surgical outcome of endoscopic third ventriculostomy (ETV) in the management of obstructive hydrocephalus.Methodology:This randomized controlled trial was conducted at the Department of Neurosurgery at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, from April 2009 to September 2010 for 1½ years. All patients presenting with obstructive hydrocephalus with the obstruction at or distal to the third ventricle and age 6 months and above were included in the study population. All the patients were divided into two groups named as Group A (experimental group) who were treated with ETV and Group B (control group) who were treated with ventriculoperitoneal shunt (VPS). The early surgical outcome was defined as outcomes within 1 month following surgical interventions. Pre- and post-operative outcomes of this study were measured.Results:A total number of sixty patients were recruited from which thirty patients were in Group A and the rest thirty patients were in Group B. The mean postoperative head circumference was 43.4 ± 7.1 cm and 47.8 ± 5.6 cm in VPS and ETV surgery, respectively (P ≤ 0.01). Postoperative vomiting was improved 24 (92.3%) in Group A and 23 (88.5%) in Group B (P < 0.05). Postoperative infection occurred in 1 (3.3%) case in Group A and 8 (26.7%) cases in Group B (P < 0.05). The success of the operation in Group A and Group B included 25 (83.3%) cases and 12 (40%) cases, respectively (P < 0.05).Conclusion:Early surgical outcome following ETV is better than VPS surgery in patients with obstructive hydrocephalus.

Endoscopic Third Ventriculostomy versus Ventriculoperitoneal Shunt in Patients with Obstructive Hydrocephalus: An Updated Systematic Review and Meta-Analysis

“…5 Rahman et al reported that the patients who underwent VPS had one epidural and one subdural bleeding (the latter resulted in death), while in the group that underwent ETV, only two unspecified intraoperative bleedings were observed. 14 Ul Haq et al reported the occurrence of one bleeding in each group of patients. 15 Even though we found no significant difference in intraoperative or postoperative bleeding events, patients who underwent VPS had clinically more severe bleedings, due to a higher occurrence of subdural and epidural hematomas, the need for new interventions, and even one death reported by Rahman et al 14 In the previous meta-analysis, there was a significant difference regarding postoperative bleeding.…”

“…Considering 30 postoperative infections reported in all five RCTs, 93.3% occurred in patients with VPS. 4,5,[13][14][15] There was a significant reduction in the total number of postoperative infections favoring ETV (RR: 0.11; 95% CI: 0.04-0.33; p < 0.0001; I 2 ¼ 0%; ►Fig. 2B).…”

Hydrocephalus secondary to tumors of the posterior fossa: review article

“…1,31,32,38,39 Definitive measures refer to surgeries that seek to restore CSF circulation (endoscopic third ventriculocisternostomy -ETV-and ventriculoperitoneal/atrial shunt -VPS/VAS-) and tumor resection. 29,32,[40][41][42][43][44][45] There is still controversy regarding the opportune moment and the therapeutic measure of choice. Faced with this dilemma, several questions arise: 1.…”

“…As in pediatric patients, the trend of recent decades places ETV above VPS/VAS. [41][42][43][44] ETV is the procedure of choice for the treatment of symptomatic obstructive hydrocephalus due to primary and/or metastatic tumor lesions, presenting good efficacy and a low rate of complications. 32,[41][42][43][44] In cerebellar metastases, the performance of ETV is similar to VPS/VAS, but at a lower cost and with less morbidity.…”

“…[41][42][43][44] ETV is the procedure of choice for the treatment of symptomatic obstructive hydrocephalus due to primary and/or metastatic tumor lesions, presenting good efficacy and a low rate of complications. 32,[41][42][43][44] In cerebellar metastases, the performance of ETV is similar to VPS/VAS, but at a lower cost and with less morbidity. EVT appears to be less effective in individuals with metastatic lesions with a history of neuroinfection, intraventricular hemorrhage, and leptomeningeal carcinomatosis.…”