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Efficiency of endoscopic third ventriculostomy in hydrocephalus caused by idiopathic obstruction of IV ventricle outlets

Abstract

Idiopathic hydrocephalus due to obstruction of the outlets of the IV ventricle is an extremely rare disease. Surgical treatment is represented by a variety methods: microsurgical, shunting and endoscopic, their combinations. microsurgical interventions are more damage, the development of endoscopic techniques make it quite justified to refuse microsurgery and difficult endoscopic interventions in favor of endoscopic third ventriculostomy.

POURPOSE OF THE STUDY: to evaluate the effectiveness of endoscopic third ventriculostomy in idiopathic hydrocephalus due to obstruction of the IV ventricle outlets.

MATERIAL AND METODS. From October 2011 to march 2021 at the Burdenko neurosurgical Institute 290 patients were operated. They met the criteria for adult idiopathic hydrocephalus: the onset of symptoms in adulthood and no indications for the etiology of hydrocephalus, as well as congenital hydrocephalus. In 18 (6,2 %) cases obstruction of the IV ventricles outlets was identify. The age of patients ranged from 26 to 74 years, averaged 47 ± 16.5 years, there were more women (61.1 %). The symptoms of the disease were headaches (77.8 %), gait disturbance (88.9 %), memory loss (72.2 %), dizziness (33 %), incoordination (27.8 %), dizziness (61.1 %), urine incontinence (27.8 %), faintings (16.6 %), hands tremor (11.1 %) The condition of patients before surgery was evaluated by the Kiefer and Rankin scales and amounted to 8,05 ± 4,34 (2–19) points and 2,6 ± 0,9 (1–5) points, respectively. Brain MRI of all patients was analyzed for different parts of cerebrospinal fluid system and changes of the position of anatomical structures.

RESULTS. Enlargement of the lateral and III ventricles was noted in all cases, enlargement of the IV ventricle in 88.8 %. The severity of the condition of the patients significantly depended on the sizes of the IV ventricle (p < 0.05) and didn’t depend on the sizes of the lateral and III ventricles. Compression of convexital subarachnoid spaces was recorded in 27.7 % of patients, and subarachnoid spaces of the posterior cranial fossa — in 72.2 %. Individually, these parameters didn’t affect the severity of the condition of the patients, but their simultaneous exposure significantly aggravated the symptoms (p < 0.05). The tonsils herniation was noted in 38.8 % cases. Standard endoscopic third ventriculostomy was performed in 83.5 % of patients. There were no complications or deaths. In 73.3 % of cases, after endoscopic surgery, there was a full recovery or near full recovery. In 26.7 % cases, hydrocephalus symptoms were regressed, but the condition of the patients was continued worse due to persistent herniation of the tonsils and progression of brainstem symptoms. They underwent microsurgical decompression of the craniovertebral junction. The average meaning the Kiefer and Rankin scales in follow-up was 2.4 ± 3.2 (0–9) and 0.9 ± 1.1 (0–4) points, respectively. There was a direct relationship between the disease history and the recovery of the patients (p < 0.05). Tonsils herniation gave significantly worse treatment results (p < 0.05). The improvement in the condition of patients was significantly associated with a decrease ventricles sizes, an enlargement of the convexital and basal subarachnoid spaces, normalization of the position of the premamillary membrane, and reposition of the cerebellar tonsils into the cranial cavity (p < 0.05).

CONCLUSIONS. Endoscopic third ventriculostomy in idiopathic hydrocephalus due to obstruction of the IV ventricle outlets is highly effective and can be used as the surgery of choice. Shunt surgery should be used as an alternative, if endoscopic surgery is impossible or ineffective. microsurgical decompression in such patients is indicated when the symptoms are getting worse due to the herniation of the cerebellar tonsils into the foramen magnum, although cerebrospinal fluid disorders were eliminated.

About the Authors

K. V. Shevchenko
Federal State Autonomous Institution “National Medical Research Center for Neurosurgery named after Academician N. N. Burdenko” of the Ministry of Health of the Russian Federation
Russian Federation

Shevchenko Kirill Victorovich

Moscow



V. N. Shimansky
Federal State Autonomous Institution “National Medical Research Center for Neurosurgery named after Academician N. N. Burdenko” of the Ministry of Health of the Russian Federation
Russian Federation

Shimansky Vadim Nikolaevich

Moscow



S. V. Tanyashin
Federal State Autonomous Institution “National Medical Research Center for Neurosurgery named after Academician N. N. Burdenko” of the Ministry of Health of the Russian Federation
Russian Federation

Tanyashin Sergey Vladimirovich

Moscow



M. V. Kolycheva
Federal State Autonomous Institution “National Medical Research Center for Neurosurgery named after Academician N. N. Burdenko” of the Ministry of Health of the Russian Federation
Russian Federation

Kolycheva Mariya Vladimirovna

Moscow



V. K. Poshataev
Federal State Autonomous Institution “National Medical Research Center for Neurosurgery named after Academician N. N. Burdenko” of the Ministry of Health of the Russian Federation
Russian Federation

Poshataev Vladimir Kirillovich

Moscow



V. V. Karnaukhov
Federal State Autonomous Institution “National Medical Research Center for Neurosurgery named after Academician N. N. Burdenko” of the Ministry of Health of the Russian Federation
Russian Federation

Karnaukhov Vasily Vitalevich

Moscow



K. D. Solozhentseva
Federal State Autonomous Institution “National Medical Research Center for Neurosurgery named after Academician N. N. Burdenko” of the Ministry of Health of the Russian Federation
Russian Federation

Solozhentseva Kristina Dmitrievna

Moscow



I. O. Kugushev
Federal State Autonomous Institution “National Medical Research Center for Neurosurgery named after Academician N. N. Burdenko” of the Ministry of Health of the Russian Federation
Russian Federation

Kugushev Ivan Olegovich



T. U. Bezborodova
Federal State Autonomous Institution “National Medical Research Center for Neurosurgery named after Academician N. N. Burdenko” of the Ministry of Health of the Russian Federation
Russian Federation

Bezborodova Tatyana Urievna

Moscow



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Review

For citations:


Shevchenko K.V., Shimansky V.N., Tanyashin S.V., Kolycheva M.V., Poshataev V.K., Karnaukhov V.V., Solozhentseva K.D., Kugushev I.O., Bezborodova T.U. Efficiency of endoscopic third ventriculostomy in hydrocephalus caused by idiopathic obstruction of IV ventricle outlets. Russian Neurosurgical Journal named after Professor A. L. Polenov. 2022;14(2):167-174. (In Russ.)

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