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0605. Intracranial endoscopy - its role in paediatrics
The past 15-20 years have seen the emergence of minimally invasive techniques
in neurosurgery. Intracranial endoscopy is one such technique, with endoscopic
third ventriculostomy (ETV) being the commonest procedure performed. In
ETV a stoma is created in the floor of the third ventricle, thereby allowing
CSF to flow freely into the subarachnoid space. The procedure is appropriate
for hydrocephalus caused by obstruction to the ventricular system anywhere
distal to the mammillary bodies. Other endoscopic procedures are fenestration
(e.g. of intracranial cysts), intraventricular biopsy, placement or retrieval
of ventricular catheters, removal of small intraventricular lesions, and
choroid plexus coagulation (used to treat communicating hydrocephalus).
Apart from being less invasive than open neurosurgery, the goal of most
of these procedures is avoidance of shunts and their complications. In
an article in a recent South African Medical Journal a group of UCT neurosurgeons
reported on their experience since introducing the technique in 1999.
Good follow-up data were available for 219 patients who altogether had
302 endoscopic procedures. Two-thirds (146) of the patients underwent
ETV, of which two-thirds were shunt free at follow-up. Congenital abnormalities
(including myelomeningocoele and Dandy-Walker syndrome) and tumours were
responsible for the hydrocephalus in most of the cases, with 27/146 listed
as post-infectious and 13/146 as post-haemorrhagic. Shunts were avoided
in ~50% of the post-infectious cases. Implied in these figures and the
text, and as previously reported by others, the procedure is not particularly
successful for non-communicating post-haemorrhagic hydrocephalus in preterm
infants, and results are much better where the hydrocephalus is the clear
consequence of an aqueductal stenosis or tumour. Some units perform choroid
plexus coagulation for communicating hydrocephalus, with avoidance of
shunts in around one-third of cases which, because of the morbidity related
to shunting, is apparently regarded as sufficiently successful to justify
the procedure.
Read more:
S Afr Med J 2006; 96: 32-7
Neurosurgery 1995; 36: 698-702
Pediatr Neurosurg 2001; 35: 131-5
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