[Neuro-endoscopic techniques in the treatment of complex hydrocephalus in children]

Abstract

The aim of the paper was to evaluate effectiveness of neuroendoscopic procedures in comparison to complex shunt systems implantation in the treatment of complex compartmentalized hydrocephalus in children. Neuroendoscopic techniques were applied in 47 patients (23 boys, 24 girls aged from 25 days to 18 years, mean age 3 years SD = 4.9 years). The shunt implantation comparison group consisted of 80 patients (47 boys and 33 girls aged from 1 day to 16 years, mean age 0.8 year, SD = 2 years). Every endoscopic procedure was planned individually, in accordance with the patient's type of complex hydrocephalus and level of deformity of his/her ventricular system. In cases of multiloculated hydrocephalus septostomy was generally performed to restore communication between separated parts of the ventricular system. In uniloculated hydrocephalus resulting from the foramen of Monro obliteration, septostomy of pellucid septi was performed to connect the isolated lateral ventricles. In cases of isolated ventricle III the foramen of Monro patency was restored to connect the ventricle with the whole ventricular system. Neuroendoscopic techniques allowed to significantly reduce the number of necessary surgical procedures. Complex hydrocephalus patients treated with the traditional shunt implantation required on the average 7 operations during the whole therapy, as compared to about 2 in those treated by means of neuroendoscopic techniques. An analysis of the number of necessary surgical interventions per year of clinical observation also indicated superiority of neuroendoscopy techniques over shunt implantation (1 vs. 4 operations per year, respectively). Neuroendoscopy allowed to simplify shunt systems in 33 children, i.e. 70.2% of those treated with neuroendoscopic techniques, while in the group treated with traditional methods of shunt implantation only 16 children (16.3%) had a simple shunt system (a shunt with one intraventricular drain). The outcome assessed according to the Glasgow Outcome Scale (GOS 1, 2) in children treated only by shunt implantation was significantly inferior to that in the neuroendoscopy group, both in terms of mortality rate (22.5 and 4.3%, respectively) and postoperative complications present in 42 (52.5%) of shunt implantation cases and 9 (19.1%) of endoscopically treated patients.

Conclusions: Neuroendoscopic techniques allowed to reduce the number of necessary operative procedures, to simplify shunt systems, to improve clinical outcome, and to reduce the risk of complications in the early postoperative period.