[Endoscopic ventriculostomy of the third ventricle in infants of less than 2 years of age].
[hydrocephalus with stenosis of the aqueduct of sylvius]
The efficiency of endoscopic ventriculostomy (EVS) of the third ventricle is noticeably lower in small children than in adults and many surgeons prefer to shunt them despite the fact that revision has to be resorted to in half of the cases. Recent reports on the successful use of EVS in infants under 2 years of age have made the authors to revise traditional views. A sample of 20 babies (mean age 9.7 +/- 4.3 months) with obstructive triventricular hydrocephalus (HC) undergone EVS at the Academician N. N. Burdenko Research Institute of Neurosurgery, Russian Academy of Medical Sciences, in 1999 to 2006. The cause of HC was intracranial infection (n = 7), hemorrhage (n = 4), aqueduct stenosis (n = 4), Galen's vein aneurysms (GVA) (n = 3), and posterior third ventricular tumors (n = 2). Postoperative follow-ups averaged 15 months. There were no deaths; overall morbidity was 10%. By and large, the efficiency of EVS was 47%. At the same time, the best results were observed in babies with GVA (100%) and aqueduct stenosis (75%). The results were significantly worse in patients with the postinflammatory (33%) and posthemorrhagic (0%) etiology of HC. In addition to the etiology, the efficiency of EVS correlated with factors, such as prolapse of the third ventricular floor into the interpeduncular cistern, the thickened and rigid floor of the third ventricle, and an analysis excluding 3 babies with GVA established a direct correlation between the dysfunction of EVS and the early manifestation of HC. Postoperative clinical improvement was attended by decreases in the anterior-posterior horn ratio in all cases and in the sizes of the third ventricle.
