MINIMALLY INVASIVE TECHNIQUE OF ENDOSCOPIC THIRD VENTRICULOCISTERNOSTOMY IN CHILDREN WITH OCCLUSIVE HYDROCEPHALUS

Abstract

Objective: To introduce into clinical practice a new minimally invasive technique of endoscopic third ventriculocisternostomy (ETV) in children with occlusive hydrocephalus with using a semi-rigid needle-shaped miniature neuroendoscope. Methods: Reviewed 131 cases (73 boys, 58 girls) occlusive hydrocephalus of various genesis in children aged 1 month to 5 years, which was performed by ETV proposed by the first author of the methodology. The period of observation of children after treatment was 24.2±3.8 months. Results: Applying a minimally invasive technique of ETV with using a semi-rigid needle-shaped miniature neuroendoscope which significantly reduced the length of the soft tissue incision in the access areas, and the use of a more advanced toolkit – to reduce the size of the twist drill hole in the skull by more than 2 times. Access to the lateral ventricle is done by means of blunt trephination of the dura without the need for significant corticectomy or coagulation and is accompanied by minimal damage to the parencima of the brain. This is very important, given the operation in children with occlusive hydrocephalus, in whom the brain is already damaged by organic changes. Constant endoscopic control when accessing the lateral ventricle increases safety and reduces the risk of damage to vascular and nerve structures. It can be performed in cases of pathologies affecting the anatomical relationships of the lateral and third ventricle such as severe narrowing or complete occlusion of the interpeduncular cistern, narrow (slit) ventricles of the brain (width of the third ventricle is less than 8 mm in the anterior sections), narrow foramen of Monro, anteroposterior size of prepontine cistern less than 6 mm. Lethal outcomes was not, and the effectiveness of surgical treatment was 77%. Postoperative neurological, endocrine and infectious complications have not been observed Conclusion: A minimally invasive technique of performing ETV using a semi-rigid needle-shaped miniature neuroendoscope is an effective and safe method of surgical treatment occlusive hydrocephalus, which minimizes surgical trauma at all stages, reduces intra- and postoperative complications and can be recommended for widespread clinical use.

Keywords

• endoscopic ventriculostomy
• obstructive hydrocephalus
• semi-rigid needle-shaped miniature neuroendoscope
• stenosis of cerebral aqueduct
• floor of the third ventricle
• basal cisterns.