Endoscopic Third Ventriculostomy Outcomes in Patients with Normal Pressure Hydrocephalus

Abstract

Background and purpose: Endoscopic third ventriculostomy (STV) is an important technique used in treatment of various forms of adult hydrocephalus and, in many cases, is more effective than traditional shunts. This study aimed at investigating the results of ETV in patients with normal pressure hydrocephalus. Materials and methods: This cross-sectional descriptive study was performed in 20 patients with normal pressure hydrocephalus attending Sari Imam Khomeini Hospital (2018-2020) after considering the inclusion/exclusion criteria. All patients were evaluated by the grading system of the Japanese Committee for Scientific Research on Intractable Hydrocephalus (JCSRIH). Pre-ETV indicators included: age, ICP, largest diameter of the frontal horns of the lateral ventricles, maximum width of cranial cavity, and Evans Ratio. The patients were evaluated before and after ETV, and also one week, one month, and 6 months later. Ventriculoperitoneal (VP) shunting was performed after one week, if there was no improvement in clinical symptoms. Results: The participants included 65% men and 35% women (mean age: 75.40 ± 4.12 and ICP: 11.35 ± 0.87 mmgh). VP shunting was carried out in 55% of the patients due to lack of improvements in clinical conditions after a week. In 45% of patients, after one week, 2-3 degrees improvements were seen in symptoms based on the JCSRIH scale (P> 0.05). Conclusion: ETV can be an effective treatment in patients with normal pressure hydrocephalus. Further studies are needed to clarify the pathophysiology of the disease and the dynamics of CSF.

Keywords

• normal pressure hydrocephalus
• endoscopic third ventriculostomy
• ventriculoperitoneal shunting