Influence of the State of the Subarachnoid Space of the Cranial Base in Hydrocephalus Resolution after Endoscopy

Abstract

To compare the resolution rate of hydrocephalus after endoscopy (predominantly endoscopic third ventriculostomy [ETV]) using flexible endoscopes during a 5-year period in patients with a permeable and a nonpermeable subarachnoid space (SAS). We conducted a retrospective cohort study of the videos and records of 150 hydrocephalic patients chosen randomly who underwent ETV (and other endoscopic procedures) with a flexible endoscope. The patients were classified into two groups based on the neuroendoscopic findings. The first group included patients with a permeable SAS, and the second group included patients with a nonpermeable SAS. A normal SAS or one with slight arachnoiditis was considered permeable. Adhesive arachnoiditis and immature or mechanically obliterated SASs were considered nonpermeable. We found a success rate of 70% in patients with a permeable SAS versus 33% in patients with a nonpermeable SAS. The baseline characteristics of both groups were homogeneous. We obtained a statistically significant difference ( < 0.0001) with hazard ratio (HR) 3.42 (95% confidence interval [CI], 1.88-6.22). Another important factor involved was age that showed a statistically significant difference ( < 0.0018) with HR 3.28 (95% CI, 1.55-6.93). The permeability of the SAS is an important prognostic factor in the resolution rate of hydrocephalus after ETV (and other endoscopic procedures) using flexible neuroendoscopes. Therefore we recommend that the characteristics of the SAS be examined following every endoscopic procedure for hydrocephalus to identify patients at risk of recurrence.

Efficacy and safety of flexible versus rigid endoscopic third ventriculostomy in pediatric and adult populations: a systematic review and meta-analysis

“…Out of the 46 case series with 3739 patients, 12 studies included adult population [7,11,13,24,25,34,35,39,40,49,50], 14 studies included pediatric population [1,4,7,8,12,29,33,45,46,51,58,60], and 20 studies included patients from both groups [2, 10, 15, 19, 21, 23, 29, 30, 37, 41-44, 47, 52, 53, 55, 56, 59]. Regarding flexible ETV, 10 studies [23,34,35,41,42,48,52,53,57,58] reported outcomes with a total of 821 patients, of whom 38 were adults, 126 were pediatric, and 657 were a mixture of adult and pediatric populations. For rigid ETV, 37 studies [1-4, 6-8, 10-13, 15, 18-21, 24, 25, 29, 30, 33, 37, 39, 40, 43-47, 49-51, 54-57, 59, 60] reported outcomes for a total of 2918 patients, of whom 1018 were adults, 747 were pediatric, and 1153 patients were a mixture of adult and pediatric populations.…”

“…Out of the 46 case series with 3739 patients, 12 studies included adult population [ 7 , 11 , 13 , 24 , 25 , 34 , 35 , 39 , 40 , 49 , 50 ], 14 studies included pediatric population [ 1 , 4 , 7 , 8 , 12 , 29 , 33 , 45 , 46 , 51 , 58 , 60 ], and 20 studies included patients from both groups [ 2 , 10 , 15 , 19 , 21 , 23 , 29 , 30 , 37 , 41 – 44 , 47 , 52 , 53 , 55 , 56 , 59 ]. Regarding flexible ETV, 10 studies [ 23 , 34 , 35 , 41 , 42 , 48 , 52 , 53 , 57 , 58 ] reported outcomes with a total of 821 patients, of whom 38 were adults, 126 were pediatric, and 657 were a mixture of adult and pediatric populations. For rigid ETV, 37 studies [ 1 – 4 , 6 – 8 , 10 – 13 , 15 , 18 – 21 , 24 , 25 , 29 , 30 , 33 , 37 ,…”