Experience with endoscopic third ventriculostomy in the management of hydrocephalus secondary to posterior fossa tumor

Abstract

Objective: To analyze the outcome of endoscopic 3rd ventriculotomy in the management of hydrocephalussecondary to posterior fossa tumor.

Methodology: Sixty five cases of hydrocephalus secondary to posterior fossa tumor underwent endoscopic3rd ventriculostomy in the Department of Neurosurgery, Lady Reading Hospital, Peshawar Pakistan fromJanuary, 2011 to June, 2012 (18 months). This was an observational study and the sampling was by simplerandom method.

Results: The study included 65 patients, 37 males, 28 females; M/F ratio, 1.32; with the age range 1-45 years. Fifty one percent (33 cases) of posterior fossa tumors occurred in children less than five years, 23% (15cases) in the 6-10 year age group, 16% (11 cases) occurred in 11-14 years and 10% (06 cases) in agegroup >14 yrs. Endoscopic third ventriculostomy was performed in 54 (83.07%) patients with successfuloutcome. Ventriculoperitoneal shunt was required in 5 (7.69%) patients for the suspicion of inadequateventriculostomy. Ventricular drainage device (EVD) was inserted in 2 (3.07%) cases for hemorrhagic CSF.In 4 (6.15%) patients no drainage procedure was done (4th ventricle floor not involved / Aqueduct openingvisible).

Conclusions: Preoperative endoscopic third ventriculostomy (ETV) control the intracranial pressure (ICP),avoid the necessity of an emergency procedure, allow appropriate scheduling of the operation for tumorremoval, and eliminate the risks related to the presence of an external drainage. The most common agegroup involved was under 5 years. The success rate of ETV was 83% and Medulloblastoma was the mostcommon Histopathological findings.