Endoscopic management of hydrocephalus. Arturo Ayala-Arcipreste MD FAANS

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trabajo presentado en el congreso mundial de neurocirugia en Boston 2009.
mas de 200 casos operados por neurocirugia endoscópica por hidrocefalia.

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Endoscopic management of hydrocephalus. Arturo Ayala-Arcipreste MD FAANS

  1. 1. Arturo Ayala Arcipreste, Rafael Mendizabal Guerra, Rubén Acosta Garcés, Gervith Reyes, Carlos Delgado. Neurosurgery Department. Hospital Juárez de México. México City. Neuroendoscopic management of Hidrocephalus on Hospital Juárez de México.
  2. 2. Background 1910 L´Espinasse inserted a cystoscope to view lateral ventricles. 1922 Dandy make a electrofulguration of coroids plexus like management of hydrocephalus. 1923 Mixter make the firts third –ventriculostomy. 1935 Fay and Grant take pictures of the lateral ventricles 1962 Bosma adapted a 8 mm camera to film the endoscopic procedures. 1963 Guiot used a quartz lens and light source to improve the image quality. 1980 to actuallity….Percnezky, Fries, Gaab, Cohen, Schroeder.. Endoscopic third ventriculostomy has gained popularity and has become the first choice for certain adult and pediatric hydrocephalus conditions.
  3. 3. Objetives Demostrate the experience of the neuroendoscopic management to resolve hydrocephalus with variate etiology in our health institution.
  4. 4. Material and Methods Retrospective and descriptive study We include all the patients operated with neuroendoscopic technique with diagnosis of hydrocephalus confirmed by image studies between 2004 and 2008 at the Hospital Juárez de México with follow up of 6 months as minimun. Total of 234 patients were treated with neuroendoscopic technique, we select 185 patients :91 males (3-83y old m:43) 94 females (4-72 y old m:37) to whom were performed a 195 neuroendoscopic procedures. All the patients had symptoms of hydrocephalus and be corroborated with image studies (CT or IRM). We used rigid neuroendoscope for all procedures.
  5. 5. Methods
  6. 6. Etiology of hydrocephalus Clinical improve (n=162) 87.5% Without improve (n=23) 12.4% Aqueductal stenosis (n= 28) 27 (16.6%) 1 (4.3%) Non communicating hydrocephalus by tumors (n= 87) 81 (50%) 6 (26%) Meningitis and cysticercosis (n= 30) 23 (14.1%) 7 (30.4%) Hydrocephalus with uncertain origen (n=19) 18 (11.1%) 1 (4.3%) Intraventricular and subarachnoid hemorrhage (n=21) 13 (18.5%) 8 (34.7%)
  7. 7. Results Clinical improve (162) Without improve (23) Age 3 to 83 years old (m:43). 4 to 72 years old (m: 37). Sex M= 84 F= 78 M= 7 F= 16 On firts 24 hours the 82% of the patients showed improve of symptoms. At 5 weeks of follow up the hydrocephalus was resolve on 80% on the CT image.
  8. 8. Results. Complications (15) 8.1% Clinical improve (162) Without improve (23) Subdural hematoma 1 0 Intraventricular Hemorrhage 1 3 Pneumoencephalus 2 2 Brain tissue Injury due to anomalus route 1 0 Meningitis 1 4 All 23 patients without improve requiered ventriculo peritoneal shunt.
  9. 9. Discussion In this serie of 185 patients with hydrocephalus treated with neuroendoscopic techniques, the 87.5% improve the clinical status, and 12.4% did not show clinical improve and requiered a ventriculo peritoneal shunt. We consider this rate succesfull. Other series reporting a success rate from 50 to 94%. Our rate of surgical complications was of 8.1%. Other series reporting a 6 to 14% on complications rate. No mortality are relationated with the surgical procedure in our serie. Inflamatory pathology like infections and events that affect the absortion mechanisms have more complications than others when the obstruction of flow is affected.
  10. 10. Discussion The indication to neuroendoscopy are changing with the time, firstly was only for non communicating hydrocephalus but the presence of intraventricular cysts clots or tumors are indicated to the procedure, including the septum fenestration and the endoscopic supervision of shunt insertion are reported. Series reported by Percknezky, Fries, Gaab, Dusick, Amin, Beems confirmed that the endoscopic managment of hydrocephalus ,mainly the third ventriculsotomy is an effective procedure to be shunt indepence.
  11. 11. Conclusion The surgical technique, and the outcome depends of the etiology of the hydrocephalus. The inflamatory pathology like infections including cysticercosis and intraventricular hemorrhage demostrated less clinical improve and higher rate of complications. The neuroendoscopic procedures to resolve hydrocephalus is safe and effective. The third-ventriculostomy is the most common endoscopic technique on the world wide for hydrocephalus. Our results are similar to world wide with endoscopic experience.

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