Endoscopic third ventriculostomy for hydrocephalus

The authors report on 125 patients who underwent endoscopic third ventricul ostomy for obstructive hydrocephalus in three Italian Neurosurgical Centers . The series includes 77 cases of primary aqueductal stenosis, 33 with triv entricular hydrocephalus due to external tumor compression, and 15 with tet raventricular hydrocephalus. The operations were carried out mainly under g eneral anesthesia, using a flexible endoscope. Decrease of size of the thir d ventricle and the presence of a signal void at the level of the fenestrat ion are the main postoperative MRI findings. Signs of intracranial hyperten sion, increased head circumference and Parinaud syndrome respond more frequ ently to the endoscopic treatment. The overall rate of good results (shunt- independent patients) in this series is 86.4%; primary aqueductal stenosis (93.5%) and triventricular hydrocephalus due to external compression (84.8% ) are associated to the higher rate! of good postoperative results than tet raventricular hydrocephalus (53.3%). Because of the very low invasivity of this technique, the absence of postoperative mortality and the scarce and u sually transient postoperative complications, the authors advise to enlarge the indications for endoscopic third ventriculostomy to all patients with obstructive hydrocephalus when the third ventricle is large enough and ther e are no alterations of the CSF resorption.