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Complex hydrocephalus (combination of communicating and obstructive type): an important cause of failed endoscopic third ventriculostomy

BACKGROUND: Hydrocephalus can be classified as purely obstructive, purely communicating or due to combinations of pathologies (obstruction in addition to defective absorption). Endoscopic third ventriculostomy (ETV) as an alternative to shunt procedures is an established treatment for obstructive hy...

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Autores principales: Yadav, Yad Ram, Mukerji, Gaurav, Parihar, Vijay, Sinha, Mallika, Pandey, Sanjay
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2009
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2717972/
https://www.ncbi.nlm.nih.gov/pubmed/19604413
http://dx.doi.org/10.1186/1756-0500-2-137
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author Yadav, Yad Ram
Mukerji, Gaurav
Parihar, Vijay
Sinha, Mallika
Pandey, Sanjay
author_facet Yadav, Yad Ram
Mukerji, Gaurav
Parihar, Vijay
Sinha, Mallika
Pandey, Sanjay
author_sort Yadav, Yad Ram
collection PubMed
description BACKGROUND: Hydrocephalus can be classified as purely obstructive, purely communicating or due to combinations of pathologies (obstruction in addition to defective absorption). Endoscopic third ventriculostomy (ETV) as an alternative to shunt procedures is an established treatment for obstructive hydrocephalus. However, patients who have combination of pathologies (complex hydrocephalus) could result in failure of ETV in spite of a patent stoma. The aim of this study was to prospectively evaluate the incidence of complex hydrocephalus in patients with obstructive hydrocephalus who failed an endoscopic third ventriculostomy. FINDINGS: Seventy one patients of obstructive hydrocephalus who underwent ETV in our institution were included in this study. Aetiology of hydrocephalus included congenital aqueductal stenosis in 42 and tubercular meningitis (TBM) in 29 patients. Failure of ETV was seen in 15 (21%) patients. These 15 patients included 6 (14.3%) from the congenital group and 9 (31.0%) patients from the TBM group. Iohexol CT ventriculography confirmed a patent stoma (suggesting a complex hydrocephalus) in 10 (66.7%) out of the 15 failed ETV cases. The incidence of complex hydrocephalus was more common in TBM group (8/29 patients, 27.60%) compared to congenital group (2/42 patients, 4.8%). The complex hydrocephalus patients with a patent ETV stoma were successfully managed by a lumbar peritoneal (LP) shunt. CONCLUSION: Ten out of the 71 patients (14%) with obstructive hydrocephalus who underwent an ETV had a complex hydrocephalus, which was the major (66.7%) cause for failure of ETV. Improving methods to detect the exact type of hydrocephalus pre-operatively could increase success rate of ETV and avoid an unnecessary operative procedure (ETV).
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spelling pubmed-27179722009-07-30 Complex hydrocephalus (combination of communicating and obstructive type): an important cause of failed endoscopic third ventriculostomy Yadav, Yad Ram Mukerji, Gaurav Parihar, Vijay Sinha, Mallika Pandey, Sanjay BMC Res Notes Short Report BACKGROUND: Hydrocephalus can be classified as purely obstructive, purely communicating or due to combinations of pathologies (obstruction in addition to defective absorption). Endoscopic third ventriculostomy (ETV) as an alternative to shunt procedures is an established treatment for obstructive hydrocephalus. However, patients who have combination of pathologies (complex hydrocephalus) could result in failure of ETV in spite of a patent stoma. The aim of this study was to prospectively evaluate the incidence of complex hydrocephalus in patients with obstructive hydrocephalus who failed an endoscopic third ventriculostomy. FINDINGS: Seventy one patients of obstructive hydrocephalus who underwent ETV in our institution were included in this study. Aetiology of hydrocephalus included congenital aqueductal stenosis in 42 and tubercular meningitis (TBM) in 29 patients. Failure of ETV was seen in 15 (21%) patients. These 15 patients included 6 (14.3%) from the congenital group and 9 (31.0%) patients from the TBM group. Iohexol CT ventriculography confirmed a patent stoma (suggesting a complex hydrocephalus) in 10 (66.7%) out of the 15 failed ETV cases. The incidence of complex hydrocephalus was more common in TBM group (8/29 patients, 27.60%) compared to congenital group (2/42 patients, 4.8%). The complex hydrocephalus patients with a patent ETV stoma were successfully managed by a lumbar peritoneal (LP) shunt. CONCLUSION: Ten out of the 71 patients (14%) with obstructive hydrocephalus who underwent an ETV had a complex hydrocephalus, which was the major (66.7%) cause for failure of ETV. Improving methods to detect the exact type of hydrocephalus pre-operatively could increase success rate of ETV and avoid an unnecessary operative procedure (ETV). BioMed Central 2009-07-16 /pmc/articles/PMC2717972/ /pubmed/19604413 http://dx.doi.org/10.1186/1756-0500-2-137 Text en Copyright © 2009 Yadav et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an open access article distributed under the terms of the Creative Commons Attribution License ( (http://creativecommons.org/licenses/by/2.0) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Short Report
Yadav, Yad Ram
Mukerji, Gaurav
Parihar, Vijay
Sinha, Mallika
Pandey, Sanjay
Complex hydrocephalus (combination of communicating and obstructive type): an important cause of failed endoscopic third ventriculostomy
title Complex hydrocephalus (combination of communicating and obstructive type): an important cause of failed endoscopic third ventriculostomy
title_full Complex hydrocephalus (combination of communicating and obstructive type): an important cause of failed endoscopic third ventriculostomy
title_fullStr Complex hydrocephalus (combination of communicating and obstructive type): an important cause of failed endoscopic third ventriculostomy
title_full_unstemmed Complex hydrocephalus (combination of communicating and obstructive type): an important cause of failed endoscopic third ventriculostomy
title_short Complex hydrocephalus (combination of communicating and obstructive type): an important cause of failed endoscopic third ventriculostomy
title_sort complex hydrocephalus (combination of communicating and obstructive type): an important cause of failed endoscopic third ventriculostomy
topic Short Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2717972/
https://www.ncbi.nlm.nih.gov/pubmed/19604413
http://dx.doi.org/10.1186/1756-0500-2-137
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