I. Cvrkota V. Bascarevic R. Mijalcic M. Micovic L. Rasulic B. Zivkovic Benefit of endoscopic third ventriculostomy for malfunctioning ventriculo-peritoneal shunt I. Cvrkota V. Bascarevic R. Mijalcic M. Micovic L. Rasulic B. Zivkovic Clinic of neurosurgery Clinical Centre of Serbia

Hydrocephalus is a disorder described as abnormal accumulation of cerebrospinal fluid (CSF) in the ventricles Usual cause of hydrocephalus is obstruction of CSF outflow Traditional treatment of choice is implantation of system for CSF drainage – ventriculo-peritoneal (VP) or ventriculo-atrial (VA) shunt In recent years new technique had developed – endoscopic third ventriculostomy (ETV), which, in chosen cases can be single treatment of hydrocephalus and treatment for malfunctioning VP shunt Introduction

Aim of this study is to determine if ETV can be treatment of choice for malfunctioning VP shunt

This study included 76 consecutive patients treated by ETV in our clinic during last ten years for malfunctioning VP shunt Our protocol was to perform ETV and next three days repeated lumbar punctures were performed for prevention of early stoma closure Control clinical and radiological examinations were conducted after one month, 6 months, 1 and 3 years Successful treatment was defined as no need for subsequent surgery for hydrocephalus after ETV Patient data were collected and statistically analyzed Material and Methods

Patients usually presented with headache (91%), sleepiness (63%), vomiting (42%), ataxia (32%) and changes in vision (17%) ETV was successful in 52 cases (68.4%) During the ETV procedure, in 25 cases shunt extraction was performed There was no statistically significant difference in success rates between groups of patients with extraction of VP shunt during the procedure and when leaving the shunt Neuroradiological examination (MRI) showing preoperative inferior bowing of the third ventricle floor was significantly correlated with ETV success (p <0.05) Complications were rare, in three cases there were wound dehiscence, and in one case transient episode of hyponatremia results

This study showed that endoscopic third ventriculostomy can be an effective treatment for chosen patients with malfunctioning shunts. When successful, the procedure eliminates the lifelong complications associated with implanted VP shunts conclusion