Ensuring Neurosurgical Equity: Setup for Safe Ventricular Endoscopy and Predictors of Clinical Outcome in a Resource-Limited Health Care System

Abstract

Background: Neuroendoscopic surgeries require specialized equipment, which may not be universally available or equitably distributed in most neurosurgical units of resource-limited healthcare systems. This review reports on the use of locally available resources to perform safe ventricular endoscopic surgeries in patients with hydrocephalus and cystic craniopharyngioma in a resource-limited healthcare system.

Methods: This study described the use of locally available resources to perform intraventricular endoscopic surgeries and retrospectively reviewed a 3-year outcome of these surgeries. A 24F, 2-way Foley catheter was used as an endoscopic working sheet. A transparent 9-mm nasotracheal tube served as a retractor and a peel-away sheath. An intravenous fluid administration set was used for irrigation. Finally, a metallic stylet of an external ventricular drain was used for third ventricular floor or cyst wall fenestration.

Results: There were 21 intraventricular endoscopic surgeries performed consisting of endoscopic third ventriculostomy (ETV), septostomy, cystostomy, and intraventricular biopsy. Four patients died, with 1 death directly related to intraoperative hemorrhage. Most (3/21) of the complications were postoperative cerebrospinal fluid leakage and partial wound dehiscence. Of the 17 surviving patients, the ETV success rate was 82.4% (14/17). Logistic regression analysis revealed that patient age, etiology, Endoscopic Third Ventriculostomy Success Score, and procedure performed were not predictive of ETV success or mortality.

Conclusions: Patients accessing neurosurgical care in resource-limited healthcare systems can benefit from safe and successful intraventricular endoscopy. However, this may require the innovative use of locally available resources that can be adapted to local neurosurgical needs.

Keywords: Clinical outcome; Hydrocephalus; Neurosurgical equity; Resource limited health care; Ventricular endoscopy.