Endoscopic Third Ventriculostomy in Post-Tubercular Meningitic Hydrocephalus: A Preliminary Report

Abstract

Hydrocephalus is a common sequel of tubercular meningitis. Endoscopic third ventriculostomy (ETV) was performed in thirty-five patients. According to the duration of illness, six patients were in the early (less than 6 weeks), nineteen were in the intermediate (6 weeks to 6 months) and ten patients were in the late phase (more than 6 months) of tubercular meningitis (TBM). Six patients were in stage I, seven patients in stage II and twenty-two patients were in stage III. The overall success rate of ETV in TBM was 77 %. Sixty percent had early and seventeen percent had delayed recovery. Obstructive hydrocephalus was present in 54.3 % and 45.7 % had communicating hydrocephalus. The radiological recovery rate was 55.6 %. The outcome with a thin to transparent floor of the third ventricle was 87 %.

Endoscopic Third Ventriculostomy in Prepontine-Suprasellar Tuberculoma with Tuberculous Meningitis Hydrocephalus: A Case Report

“…In the last 3 years, there are few reports showing the effectiveness of ETV in TBMH [1,2,3,4,5,6]. Factors affecting the outcome in such cases are still not identified.…”

“…Perforation of the thick and adherent third ventricular floor in patients with TBMH is not feasible or safe, and external shunt remains the option in these patients [1, 5, 6]. ETV is usually done with the patient in supine position, with the head in neutral position, which is not suitable for external shunt surgery, as the passage of the shunt tube through the subcutaneous space of the neck will not be possible.…”

“…Various modalities of treatment are available, including conservative treatment with dehydrants, external shunt and external ventricular drain with or without external shunt. Recently, endoscopic third ventriculostomy (ETV) has been found effective in TBMH, and an increasing number of neuroendoscopists are offering ETV to such patients [1,2,3,4,5,6,7]. To date, factors affecting the outcome of ETV in TBMH are not identified.…”

Endoscopic Third Ventriculostomy: The Lebanese Experience

“…Excellent outcomes and high long-term success rates ranging from 60 to 100% have been reported in both adult and pediatric series of OHC [2,3,4,5,6,7,9,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31]. Our 81.6% overall success rate is thus comparable to those of previous reports.…”

“…Although most authors agree that AS and tumor-related OHC constitute the best indications for ETV and are associated with the highest success rates [3,5,6,8,14,16,17,22,23,24,25,27,28,33,34,35,36,37,38], ETV is gaining more and more acceptance as an effective treatment for other forms of hydrocephalus, including those resulting from myelomeningocele [12], Chiari I malformation [9], tuberculous meningitis [19], and even idiopathic normal-pressure hydrocephalus [30] and posthemorrhagic and postinfectious hydrocephalus [18,39,40]. In addition to being an internal shunt, ETV is thought to restore the pulsatility of the ventricular walls, which results in restoration of CSF flow from the ventricular system into the subarachnoid spaces and normalization of CSF dynamics, which may account for its effectiveness in some cases of communicating hydrocephalus [25].…”