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The role of endoscopic third ventriculostomy in adult patients with hydrocephalus.
[hydrocephalus with stenosis of the aqueduct of sylvius]
Endoscopic
third
ventriculostomy
(
ETV
)
is
the
treatment
of
choice
for
hydrocephalus
,
but
the
outcome
is
dependent
on
the
cause
of
this
disorder
,
and
the
procedure
remains
principally
the
preserve
of
pediatric
neurosurgeons
.
The
role
of
ETV
in
adult
patients
with
hydrocephalus
was
therefore
investigated
.
One
hundred
ninety
adult
patients
underwent
ETV
for
hydrocephalus
.
Cases
were
defined
as
primary
ETV
(
newly
diagnosed
,
without
a
previously
placed
shunt
)
and
secondary
ETV
(
performed
for
shunt
malfunctions
due
to
infection
or
mechanical
blockage
)
.
Causes
of
hydrocephalus
included
tumor
,
long
-standing
overt
ventriculomegaly
(
LOVA
)
,
Chiari
malformation
Types
I
and
II
(
CM-
I
and
-
II
)
,
aqueduct
stenosis
,
spina
bifida
,
and
intraventricular
hemorrhage
(
IVH
)
.
Successful
ETV
was
defined
as
resolution
of
symptoms
with
shunt
independence
.
Operative
complications
and
ETV
failure
rate
were
investigated
according
to
the
causes
of
hydrocephalus
and
between
the
primary
and
secondary
ETV
groups
.
In
the
primary
group
,
ETV
was
successful
in
107
(
83
%
)
of
129
patients
,
including
those
with
tumors
(
52
of
66
)
,
LOVA
(
21
of
24
)
,
CM-
I
(
11
of
11
cases
)
,
CM-
II
(
8
of
9
)
,
aqueduct
stenosis
(
8
of
9
)
,
and
IVH
(
2
of
2
)
.
In
the
secondary
group
,
ETV
was
successful
in
41
(
67
%
)
of
61
patients
and
was
equally
successful
in
cases
of
mechanical
shunt
malfunction
(
35
of
52
patients
)
and
infected
shunt
malfunction
(
6
of
9
patients
)
.
The
median
time
to
ETV
failure
was
1
.
7
months
in
the
primary
group
and
0
.
5
months
in
the
secondary
group
.
The
majority
of
ETV
failures
occurred
within
the
first
3
months
,
and
thereafter
,
the
Kaplan-
Meier
survival
curves
plateaued
.
There
were
no
procedure-related
deaths
,
and
complications
were
seen
in
only
5
.
8
%
of
cases
.
The
success
rate
of
ETVs
in
adults
is
comparable
,
if
not
better
,
than
in
children
.
In
addition
to
the
well-defined
role
of
ETV
in
the
treatment
of
hydrocephalus
caused
by
tumors
and
aqueduct
stenosis
,
ETV
may
also
have
a
role
in
the
management
of
CM-
I
,
LOVA
,
persistent
shunt
infection
,
and
IVH
resistant
to
other
CSF
diversion
procedures
.
Diseases
Validation
Diseases presenting
"and ivh resistant to other csf diversion procedures"
symptom
hydrocephalus with stenosis of the aqueduct of sylvius
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