Endoscopic Third Ventriculostomy

Objectives: In the present paper we report and discuss our experience with endoscopic third ventriculostomies (ETVs). We will point out surgical, technical data and complicationsinvolved. Methods: Between September 1995 and August 2007, we selected 283 patients with hydrocephalus which were submitted exclusively to ETV. Results: In our series, 145 (51.24%) patients were male, and 138 (48.76%) female. Age varied from 2 days to 83 years-old (medium of 15 years and 8 months). Most of the patients had obstruction at the cerebral aqueduct level (aqueduct stenosis, benign tectal tumors). In our series there was not a single death directly due to the procedure. However 20 patients (7%) evolved with post-surgical complications and 3 of them were permanent, with memory deficit in one and epilepsy in two. There was failure in the procedure during the early post-surgical eriod in 37 (13%) patients, who then needed ventricular shunt systems to resolve hydrocephalus. Conclusions: Our results suggest that ETV should be considered as the initial treatment to hydrocephalus in all patients whose magnetic resonance exams shows a site of obstruction to the CSF flow. We consider that the most important factor to the treatment success is the adequate selection of patients. Objetivos: Neste trabalho, relataremos nossa experiencia na realizacao de terceiroventriculostomias endoscopicas (TVE's). Discutiremos dados tecnicos, cirurgicos e as complicacoes ocorridas. Metodos: No periodo de Setembro de 1995 a Agosto de 2007, selecionamos 283 pacientes com hidrocefalia submetidos exclusivamente a TVE. Resultados: Na nossa serie, 145 (51,24%) pacientes eram do genero masculino e 138 (48,76%) do genero feminino. A idade variou entre 2 dias a 83 anos de vida (media de 15 anos e 8 meses). A maioria dos pacientes apresentava obstrucao ao nivel do aqueduto cerebral (estenose aquedutal, tumores tectais). Na nossa serie, nao houve nenhum obito relacionado ao procedimento. Entretanto, 20 (7%) pacientes evoluiram com complicacoes pos-operatorias sendo tres permanentes, um com deficit de memoria e dois com epilepsia. Ocorreu falha do procedimento no periodo pos-operatorio precoce em 37 (13%) pacientes que necessitaram de sistemas de derivacao ventricular para resolucao da hidrocefalia. Nossos resultados sugerem que a TVE deve ser considerada o tratamento inicial da hidrocefalia em pacientes cujos exames de ressonância magnetica evidenciem um sitio de obstrucao ao fluxo liquorico. Consideramos que o fator mais importante para o sucesso do tratamento e a adequada selecao dos pacientes.