Neuroendoscopic surgery for specific forms of hydrocephalus

Neuroendoscopic surgery was used to treat patients with various forms of hy drocephalus with specific pathophysiology, including long-standing overt ve ntriculomegaly in adulthood (LOVA), isolated unilateral hydrocephalus (IUH) , isolated IV ventricle (IFV), disproportionately large IV ventricle (DLFV) , isolated rhombencephalic ventricle (IRV), isolated quarto-ventriculomegal y (IQV), dorsal sac in holoprosencephaly (DS), and loculated ventricle (LV) . A total of 26 operative procedures were performed, with neuroendoscopic s urgery in 22 patients, 12 with unique forms of noncommunicating hydrocephal us and 10 with various types of postshunt isolated compartment. These proce dures included III ventriculostomy, aqueductal plasty by both rostral and c audal approaches, foraminal plasty in the Foramen of Monro/foramen of Magen die, septostomy, IV ventriculostomy, fenestration of septation in the locul ated ventricle, fenestration of arachnoid cyst or cystic tumor obstructing a ventricle with or without tumor removal, and dorsal sac ventriculostomy. The characteristics of the cerebrospinal fluid (CSF) dynamics in the indivi dual specific pathophysiologies were delineated by cardiac-gated cine-mode magnetic resonance imaging (MRI) before and after the endoscopic procedure, The consequent success rate (success = restoration of communication of the CSF pathway in the individual patients) was 19/22 (86.4%). The progression of ventricular dilatation was stopped in 17 of 19 patients (89.5%) in whom the endoscopic procedure was successful (radiologically arrested hydroceph alus). Improvement in the clinical symptoms and signs (clinically arrested hydrocephalus) was obtained in 15 of the patients (68.2% of all patients: 5 with LOVA, 3 with IQV, 5 with IUH and 2 with LV). Seven patients (2 LOVA, 2 IFV, I DS, 1 DFLV and 1 IRV) underwent a shunt procedure after the neuroe ndoscopic procedure(s). The postoperative changes of ventriculomegaly were complicated, reflecting the differences in the brain parenchymal compliance and postoperatively corrected CSF flow dynamics in the major CSF pathway.