A Comparative Study Between Ventriculoperitoneal Shunt and Endoscopic Third Ventriculostomy in the Manegment of Obstructive Hydrocephalus
Iraqi Postgraduate Medical Journal,
2014, Volume 13, Issue 4, Pages 486-492
Uncertainty persists on the best treatment for patients with obstructive hydrocephalus: endoscopic third ventriculostomy (ETV) or V-P shunt. Most patients with obstructive hydrocephalus are treated with ventriculo-peritoneal (VP) shunt placement.
Of this study is to compare between V-P shunt and ETV in the manegment of obstructive hydrocephalus in relation to the degree of complication.
This is a prospective study of 90 patients with obstructive hydrocephalus of various etiologies operated by V-P shunt or Endoscopic 3rdventriculostomy in the Department of Neurosurgery in Al-Khdhemia Teaching Hospital, Neurosciences Teaching Hospital and Neurosurgical Teaching Hospital from October 2011 to December 2012. Presenting symptoms and signs, clinical shunt function, operative findings and outcome were recorded.
Common presenting features were headache, vomiting, irritability and general toxic look of patients. Male to female ratio was 1.14:1. Patients with obstructive hydrocephalus were treated with V-P shunt or with endoscopic third ventriculostomy and followed for 6 months as an average. In patients with V-P shunts, upper end block was a common problem followed by wound dehiscence and valve exposure and other complications such as lower end obstruction, slipped catheter, subdural hematoma, and subcutaneous CSF collection. While in patients with ETV spontaneous closure of the stoma was more frequent than other complications. The complication rate in ETV is lower than that of V-P shunt (30% in V-P shunt and 17% in ETV). However ETV is less successful in patients below 2 years old and in those with normal pressure hydrocephalus.
Endoscopic third ventriculostomy is becoming more popular as an alternative to shunting in the management of obstructive-type hydrocephalus. Obstructive hydrocephalus is the main indication for endoscopic third ventriculostomy. However, in cases where this procedure is indicated, good knowledge of third ventricle anatomy, surgeon preference and experience with endoscopic surgery can yield success rates of up to 80%.
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