Endoscopic Third Ventriculostomy: The Art of Driving | ||
| Al-Azhar International Medical Journal | ||
| Volume 2023, Issue 1, January 2023 | ||
| DOI: 10.58675/2682-339X.1719 | ||
| Author | ||
| Alhusain Nagm | ||
| Department of Neurosurgery, Al-Azhar University School of Medicine, Cairo, Egypt | ||
| Abstract | ||
| Background: Ensuring effective Endoscopic Third Ventriculostomy (ETV) based on sufficient scientific knowledge and wise decision-making will enhance the outcome. Methods: A 3-year retrospective study including postoperative ETV cases of both sexes with obstructive hydrocephalus due to aqueductal stenosis/tumor with preoperative ETV-SS ≥ 70, age ≥ 6 to 600 months and follow-up for ≥ 6 months with a postoperative radiological evaluation of the ETV-patency and cerebrospinal fluid dynamics. Results: Among our 147 case series, 93 patients were included in this study. Patient demographics showed age distribution between infants, children, preadolescence, and adults were 83.8%, 1.3%, 2.7 and 12.2%, respectively. Aqueductal stenosis or tumor was 93.6% and 6.4%, respectively. All infants were presented with aqueductal stenosis. Whereas, a child (16.6%) and five adults (83.4%) presented with aqueductal tumors. The ETV success rate was 74%. We appreciated three types of Liliequist membrane (LM): thick/dense (33.3%), thin/transparent (63.3%) and fenestrated (3.4%). The failure was significantly attributed to inadequate communication with the basal cistern due to difficult/unsafe perforation of the thick/dense LM (P = 0.001), particularly in infantsmonths. Conclusion: Proper candidate selection, adequate LM opening with reasonable visual confirmation of the basal cistern and appropriate follow-up will upsurge the ETV success rate. Clarifying specific nuances can lead to do fruitful ETV. | ||
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