Endoscopic treatment of hydrocephalus in children: A controlled study using newly developed Yamadori-type ventriculoscopes

Although cerebrospinal fluid (CSF) shunting is the most common neurosurgica l treatment for hydrocephalus, the long-term results have still been unsati sfactory because of a wide variety of shunt complications. We have recently developed flexible ventriculoscopes (Yamadori-type) which have excellent i mage quality, maneuverability, and capabilities for endoscopic operation. H ere we report the efficacy of the new treatment in 88 children with hydroce phalus who initially underwent either ventriculoscopic operation or shuntin g surgery. The primary outcome measures were the rate of shunt independency and/or shunt complications with a follow-up of 2 years in each group. We p erformed endoscopic third ventriculostomy in cases of aqueductal stenosis, cyst fenestration, and choroid plexus coagulation in limited cases of commu nicating hydrocephalus. Overall, thirty-three (75%) of the 44 children init ially treated endoscopically did not require ventriculoperitoneal (VP) shun ts. The endoscopic procedures were repeated in the remaining 11 children (2 5%) mostly less than 1-year-old who ultimately required endoscope-guided VP shunting. Even in such patients, there was virtually no need for shunt rev isions and no major complications such as slit-like ventricle, meningitis, and intraventricular hemorrhage. These results were statistically highly si gnificant (p <0.0001) compared to a control group of 44 patients treated in itially by VP shunting. Our data demonstrate that therapeutic ventriculosco py is safe and clinically effective as the first-line treatment of hydrocep halus in children.