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A Journal on Neurosurgery


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Journal of Neurosurgical Sciences 2001 June;45(2):92-6

language: English

Neuroendoscopic ­approach to com­plex hydro­ceph­a­lus. Personal expe­ri­ence and pre­lim­i­nary ­report

Cipri S., Gambardella G.

Department of Neurosurgery, Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria, Italy


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Background. Neuroendoscopic pre­mam­mi­lary ­third-ven­tri­cu­lo­cis­ter­nos­to­my in non-com­mu­ni­cat­ing hydro­ceph­a­lus rep­re­sents, to ­date, the ­less inva­sive and effec­tive pro­ce­dure, where­as the neu­ro­en­do­scop­ic ­approach to com­plex-hydro­ceph­a­lus is lim­it­ed to sev­er­al ­small anec­do­tal ­series.
Methods. Among 57 pedi­at­ric ­patients affect­ed by ostruc­tive hydro­ceph­a­lus, rang­ing in age ­from pre­na­tal diag­no­sis to 3 ­years (­mean 1.2 ­year±11 ­months) and recruit­ed ­over a 2-­year peri­od, we iden­ti­fied 11 cas­es ­with presur­gi­cal neu­ro­ra­dio­log­i­cal com­plex-hydro­ceph­a­lus, at admis­sion to our Department. In two cas­es Magnetic Resonance imag­ing ­showed bilat­er­al atres­ic fora­men of Monro and cor­pus cal­lo­sum age­nes­ya. In ­these cas­es an extra­cra­ni­al cere­bro­spi­nal ­fluid ­shunt dev­ice was implant­ed. The ­authors ­report ret­ro­spec­tive­ly, the per­son­al expe­ri­ence on a ­series of 9 pedi­at­ric ­patients ­with complex-hydrocephalus, ­such as mul­ti­shunt­ed (4 cas­es), mul­ti­loc­u­lat­ed hydro­ceph­a­lus (3 cas­es), and mul­ti­ple ven­tric­u­lar ­cysts ­plus hydro­ceph­a­lus (2 cas­es), in ­which a neu­ro­en­do­scop­ic ­approach was per­formed. At admis­sion, symp­toms and ­signs of an ­increased intra­cra­ni­al pres­sure ­were ­presents in all cas­es. Follow-up ­ranged ­from 3 ­months to 2 ­years. In 8 cas­es ­third ven­tric­u­los­to­my was suc­cess­ful­ly per­formed where­as, in one ­case, the endo­scop­ic pro­ce­dure, in a ­patient young­er ­than 1 ­month, was abort­ed and an extra­cra­ni­al cere­bro­spi­nal ­fluid ­device was implant­ed.
Results. In the post­op­er­a­tive peri­od and dur­ing fol­low-up, a symp­to­mat­ic ­relief and clin­i­cal improve­ment of pre­op­er­a­tive ­signs ­and symp­toms of ­increased intra­cra­ni­al pres­sure was ­seen in all cas­es. Nevertheless, in two ­patients psy­cho­mot­­or retar­da­tion wors­ened, respect­ively 6 and 7 ­months ­after the endo­sco­pic pro­ce­dure and ­then, an addi­tion­al extra­cra­ni­al cere­bro­spi­nal ­fluid ­shunt ­device was implant­ed.
Conclusions. In our select­ed cas­es of com­plex-hydro­ceph­a­lus, the neu­ro­en­do­scop­ic ­approach did not ­fail to deter­mine clin­i­cal improve­ment ­after the ­first pro­ce­dure, in ­spite of ­increased tech­ni­cal dif­fi­cul­ties and min­i­mum decreas­es of ven­tric­u­lar vol­ume in post­op­er­a­tive imag­es.

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