ENDOSCOPIC THIRD VENTRICULOSTOMY: OUTCOME ANALYSIS IN 170 PROCEDURES
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Abstract
OBJECTIVE: To analyze the outcome of endoscopic third ventriculostomy (ETV) in the management of obstructive hydrocephalus (OHC).
METHODOLOGY: This observational study was conducted at department of neurosurgery, Lady Reading hospital, Peshawar Pakistan from January 2009 to June 2012. During the study period, 130 cases of OHC secondary to posterior fossa tumor undergoing ETV were selected for study through convenient sampling method. The exclusion criteria consisted of patient’s age <6 months, previous history of ETV, recurrent tumor, and Kornofsky score <60. Data was collected on a proforma and analyzed by SPSS-16.
RESULTS: Out of 170 patients, 94 (55.3%) were males and 76 (44.7%) were females, ranging in age from 1-45 years. Ninety (52.9%) cases were <5 years of age and 45 cases (26.5%) were in the 6-10 year age group. ETV had successful outcome in 135 (79.4%) patients. Ventriculoperitoneal shunt was required in 14 (8.24%) patients for inadequate ventriculostomy. Ventricular drainage device was inserted in 8 (4.7%) cases for hemorrhagic CSF. Complications were observed in 39 (22.9%) cases including inadequate ventriculostomy (8.24%), ventricular bleed (4.7%), CSF leak (2.4%), asymptomatic pneumocephlus (1.2%), seizures (1.2%) and meningitis (1.2%). Five patients (2.94%) died; 2 (1.2%) each due to reverse conning and ventricular bleed and one (0.6%) due to CSF leak with meningitis.
CONCLUSION: ETV has success rate of 79.4% in OHC with complication rate of 22.9% and mortality rate of 2.94%. Complications can be reduced by proper selection of patients, detailed plan and skilful performance of surgery in experienced hands and meticulous postoperative care.
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