Endoscopic Third Ventriculostomy in Patients with Idiopathic Normal Pressure Hydrocephalus

Abstract

Objective: High rates of shunt complications in treatment of hydrocephalus has led neurosurgeons to find alternative methods. Endoscopic Third Ventriculostomy (ETV) is the transfer of CSF into interpeduncular and prepontine cisternas by perforating the floor of third ventricle. It is important for obstructive hydrocephalus. Effectiveness in communicating hydrocephalus hasn’t been well elucidated. However success rates approaching 50%, have been reported in Idiopathic Normal Pressure Hydrocephalus (iNPH) (Adams-Hakim Syndrome). Our aim is evaluate the success rates of our patients.

Materials and Methods: 20 patients underwent ETV with diagnosis of iNPH, between April 2017 and January 2023, were included. Ages, duration of symptoms and preoperative Mini-Mental Status Test (MMST) scores were recorded. Ventriculoperitoneal shunt (VPS) was inserted in whose clinical findings didn’t improve during the follow-ups.

Results: Success was provided in 12 of 20 patients. In patients achived success, mean age was 67, duration of symptoms 4 months, and preoperative MMST score 19. 7 patients who needed shunt, mean age was 77 years, duration of symptoms 10 months, MMST score 14.

Conclusion: ETV may be an alternative intervention to shunt therapy in iNBH. Patients under 75 years of age, with not very impaired cognitive functions and with symptoms duration less than 6 months are important criterias for the success of ETV. If the patient has over 75 years of age, has poor mental status, symptomatic more than 6 months, ventriculostomy may not be sufficient to improve the decreased perfusion in periventricular microischemic areas. In these cases, VPS should be the first choice.