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Outcome prediction of third ventriculostomy: a proposed hydrocephalus grading system.
[hydrocephalus with stenosis of the aqueduct of sylvius]
An
important
factor
in
making
a
recommendation
for
different
treatment
modalities
in
hydrocephalus
patients
(
VP
shunt
versus
endoscopic
third
ventriculostomy
)
is
the
definition
of
the
underlying
pathology
which
determines
the
prognosis
/
outcome
of
the
surgical
procedure
.
Third
ventriculostomies
(
3rd
VS
)
are
successful
mainly
in
obstructive
hydrocephalus
but
also
in
some
subtypes
of
communicating
hydrocephalus
.
A
simple
,
easily
applicable
grading
system
that
is
designed
to
predict
the
outcome
of
3rd
VS
is
proposed
.
The
hydrocephalus
is
graded
on
the
basis
of
the
extent
of
downward
bulging
of
the
floor
of
the
third
ventricle
,
which
reflects
the
pressure
gradient
between
the
3rd
ventricle
and
the
basal
cisterns
,
presence
of
directly
visualised
CSF
pathway
obstruction
in
MRI
,
and
the
progression
of
the
clinical
symptoms
resulting
in
five
different
grades
.
In
this
proposed
grading
system
,
grade
1
hydrocephalus
subtype
shows
no
downward
bulged
floor
of
the
3rd
ventricle
,
no
obstruction
of
the
CSF
pathway
,
and
no
progressive
symptoms
of
hydrocephalus
.
There
is
no
indication
for
3rd
VS
.
Grades
2
to
4
show
different
combinations
of
the
described
parameters
.
Grade
5
subtype
shows
a
markedly
downward
bulged
floor
of
the
3rd
ventricle
and
direct
detection
of
the
CSF
pathway
obstruction
(
i
.
e
.
,
aqueductal
stenosis
)
with
progressive
clinical
deterioration
.
Retrospective
application
of
this
grading
scheme
to
a
series
of
72
3rd
VS
has
demonstrated
a
high
correlation
with
the
outcome
:
The
success
rate
in
grade
3
reached
40
%
,
in
grade
4
:
58
%
,
and
in
grade
5
:
95
%
.
This
standardised
grading
system
predicts
the
outcome
of
3rd
VS
and
helps
in
decision
making
for
3rd
VS
versus
VP
shunting
.
Diseases
Validation
Diseases presenting
"presence of directly visualised csf pathway obstruction in mri"
symptom
hydrocephalus with stenosis of the aqueduct of sylvius
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