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  • Endoscopic Third Ventriculostomy (ETV) for Treatment of Adult Hydrocephalus: Long-term Followup With 163 Patients

    Final Number:
    336

    Authors:
    Albert Issacs MD; Mark G. Hamilton MD, FRCSC

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2015 Annual Meeting

    Introduction: Treatment of specific patterns of symptomatic hydrocephalus in the adult patient may be accomplished with endoscopic third ventriculostomy (ETV) as an alternative to insertion of a ventriculoperitoneal (VP) shunt or when VP shunt failure occurs. Treatment of hydrocephalus with a VP shunt, while effective, is associated with a significant shunt failure rate that results in VP shunt revision surgery. This review examines a single center experience with ETV to treat hydrocephalus in symptomatic adult patients.

    Methods: Adult patients (=18 years) with a diagnosis of hydrocephalus who were treated with ETV in Calgary between January 1994 and July 2014 were reviewed using a clinic database and registry. All patients were treated by one neurosurgeon.

    Results: 163 adult patients with symptomatic hydrocephalus treated with ETV were identified (male=92; female=71). Mean age at the time of ETV was 46.5 years (range 18-83.4 years). 118 underwent ETV as a primary treatment and 45 patients underwent treatment after presenting with VP shunt failure (secondary ETV). 113/163 patients had a diagnosis of aqueductal stenosis, 22/163 had a diagnosis of tumor. Mean followup was 8.2 years (range 0.3-18.4 years). Symptoms in 149/163 (91.4%) of ETV patients were better or unchanged at last followup. 104/118 (88.1%) of primary ETV patients were shunt free at last followup. 39/45 (86.7%) of secondary ETV patients were shunt free at last followup.

    Conclusions: Endoscopic (ETV) treatment of hydrocephalus is an effective long-term treatment in a select population adult patients with hydrocephalus. Outcome/results are similar for patients where ETV is used as either a primary or secondary treatment. 87-88% of patients remain shunt free with a mean 8.2 years of followup.

    Patient Care: ETV has a very significant and effective role in the treatment of select adult patients with hydrocephalus. The long-term results are excellent and this procedure has the potential to avoid many of the complications and issues associated with VP shunt surgery.

    Learning Objectives: 1) To understand the role of ETV for primary treatment of hydrocephalus in the adult patient. 2) To understand the role of ETV for secondary treatment of hydrocephalus in the adult patient.

    References:

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