Endoscopic approach to noncommunicating fluid spaces in the shunted patient

Introduction: It is well known that shunted hydrocephalic patients can, ove r time, develop entrapped ventricles or cystic spaces not in communication with the remaining ventricles, This situation has traditionally been treate d with placement of an additional catheter or shunt system in the noncommun icating fluid space. With the advent of minimally invasive endoscopic techn iques, it has become possible to fenestrate trapped fluid spaces into the s hunted ventricular system, thus preventing the need for additional catheter s. Methods: Fifteen shunted patients presented with noncommunicating fluid spa ces over a 4-year period at our two institutions. We attempted fenestration procedures in 14 of those patients. The various procedures included: septu m pellucidum fenestration, cyst fenestration, third ventriculocisternostomy and a combination of the above. Results: Thirteen of 16 (81%) endoscopic fenestrations successfully prevent ed the need for a complicated shunting system. There were 3 technical failu res (3/16, 19%) in which an additional catheter was added to the existing s hunt system at the time of the endoscopic procedure. There were no adverse neurologic effects from the endoscopic procedures; however, in 4 of the 14 patients (29%) a shunt revision was performed between 2 and 30 days followi ng the fenestration. Conclusions: These results show that the endoscopic approach to establishin g communication between noncommunicating CSF spaces in the shunted patient is safe and efficacious in preventing the need for additional CSF catheters . Though we encountered failures, the majority of cases are technically fea sible, In these patients early shunt malfunction may occur, most likely due to intraoperative bleeding and will require shunt revision. Copyright (C) 2000 S. Karger AG, Basel.