神经内镜治疗脑室内蛛网膜囊肿

目的探讨神经内镜手术治疗脑室内蛛网膜囊肿的疗效。方法 2008年3月～2010年3月应用外径4mm0°硬性脑室镜(德国Rodolf公司)治疗20例脑室内蛛网膜囊肿,其中侧脑室16例,三脑室4例,术中根据囊肿的部位、囊肿与脑室壁的粘连情况、室间孔及中脑导水管是否闭锁分别施行囊肿切除、囊肿造瘘、囊肿造瘘+透明隔造瘘或三脑室底造瘘术。结果内镜下脑室囊肿造瘘术12例,其中2例室间孔闭锁同时行透明隔造瘘,4例中脑导水管梗阻同时行三脑室底造瘘术;内镜下囊肿切除8例,其中次全切除3例,部分切除5例。术后无出血、感染及神经功能缺失等并发症。20例随访3～6个月,平均5个月,20例术后症状均改善。结论神经内镜手术治疗脑室内蛛网膜囊肿具有操作简单、创伤小、术后恢复较快、疗效较好等优点。     

脑囊虫病的软性神经内镜治疗

目的探讨应用软性神经内镜治疗脑囊虫病的疗效。方法 2007年10月～2011年1月,应用软性神经内镜(主机为FUJINON EPX-2200电子视频内镜系统;镜体为FUJINON EB-270P超细软性内镜,外径3.8 mm,工作通道直径1.2mm,观察视野120°,工作长度365 mm)治疗脑囊虫病15例,其中7例为院外脑室-腹腔分流术后分流故障。术中经额部钻孔,内镜下先行透明隔及第三脑室底造瘘,导水管闭塞者加行导水管成形,对脑室及基底池全面探查,摘除所见囊虫囊泡,灌洗清洁脑室。结果 15例顺利完成手术,摘除脑室或基底池内所见囊虫囊泡,7例脑室-腹腔分流术后均成功摆脱了分流依赖。镜下手术时间15～40 min,(26±8)min。出血量15～50 ml,(27±6)ml。除2例术后出现高热延迟出院外,其余13例均于术后6 d出院。15例术后随访8～46个月,平均29.8月,术前症状缓解,无复发及其他不良反应,磁共振检查示脑积水缓解,导水管区、第四脑室正中孔及第三脑室底瘘口脑脊液流动良好。结论电子神经内镜下经单侧额部钻孔侧脑室入路可对整个脑室系统及基底池进行探查,寻找并摘除囊虫囊泡,手术操作简便,创伤小,恢复快。     

第三脑室底造瘘治疗脑积水的手术并发症

目的 探讨第三脑室底造瘘治疗脑积水产生手术并发症的原因及预防措施。方法 对13例（15例次）行第三脑室底造瘘术治疗脑积水出现并发症的情况进行回顾性分析。结果 本组患者出现脑室内感染2例、膜膜下积液1例、造瘘口再堵塞1例、术中出血后的血凝块堵塞第三脑室形成脑疝1例。并发症的主要原因为手术设备的不良和先期经验的不足。结论 采用良好的手术设备,提高对各种并发症发生原因的不足,可减少手术并发症的发生。     

脑室镜治疗33例梗阻性脑积水

目的 探讨脑室镜在梗阻性脑积水中的治疗方法和技巧. 方法 2003年6月～2006年12月,采用脑室镜治疗梗阻性脑积水33例,术前均行头部CT、MRI、同位素99mTc-DTPA脑池显像检查,行脑室镜下第三脑室造瘘术. 结果 32例造瘘成功,1例瘘口下出血放弃治疗死亡.13例手术后发热,1例手术后6个月双侧慢性硬膜下血肿(经钻孔引流后痊愈),3例术后6个月手术侧硬脑膜下积液(因无特殊不适予以随访观察).随访2～42个月,平均16.7月,32例手术后临床症状均缓解.32例造瘘手术前腰穿测压平均26(16～39) cm H2O,手术后7天为22(11～28) cm H2O,术后7天颅内压显著下降(t=2.903,0.005＜P＜0.01).术后7天复查CT、MRI,25例侧脑室体部横径较术前缩小,平均缩小2.3(0.7～4.6)mm,7例侧脑室大小无变化;32例侧脑室旁水肿均消失.1例术前合并小脑扁桃体下疝者手术后7天复查MRI见下疝的小脑扁桃体向上移位4 mm. 结论 脑室镜手术是治疗梗阻性脑积水的安全有效的方法.     

后腹腔镜重复肾重复输尿管切除16例报告

目的：探讨后腹腔镜重复肾切除的可行性和疗效。方法：2005年6月～2010年10月行后腹腔镜下重复肾切除术17例,其中男5例,女12例,年龄12～72岁,平均40．4岁。17例均位于‘肾上极。2例因体检发现肾积水就诊;12例因腰痛伴发热就诊;3例因尿失禁就诊。17例患者均术前行磁共振尿路水成像（MRU）、IVu或CT片确诊重复肾,16例重复肾位于左侧,1例患者为右侧重复肾伴积水左侧肾缺如,行右肾穿刺造瘘术。结果：16例手术时间80～200min,平均110min。出血量40～400ml,平均70．5mI。术中转开放手术1例;术中损伤正常肾盂肾盏2例。术后肠道功能恢复时间1～3．5天,平均2天,术后住院时间6～8天,平均7天。术前平均血尿素氮（5．8±1．1）mmol／L,血肌酐（70．4±26．5）“mol／L。术后随访3个月,平均血尿素氮（6．0±1．0）mmol／L,血肌酐（81．8±19．2）μmol／L。两组差异无统计学意义（P〉0．05）。患者术前原有症状消失,术后3～24个月B超复查均未见重复肾。结论：后腹腔镜重复肾切除术安全可靠,疗效良好,患者恢复速度快。     

神经内镜下第三脑室底造瘘术治疗脑积水11例分析

目的探讨神经内镜下第三脑室底造瘘术（ETV）治疗脑积水的手术技巧、疗效及并发症的预防。方法回顾性分析2008年7月至2010年8月接受ETV的11例脑积水患者的临床资料,其中梗阻性脑积水8例,交通性脑积水3例。复习相关文献资料进行分析。结果 9例患者临床症状明显好转,1例临床症状未见明显变化,1例术后出现造瘘口闭合,行脑室-腹腔分流术后临床症状好转。结论 ETV治疗脑积水符合生理结构,安全有效,并发症少,应大力推广此手术方式。     

新生儿坏死性小肠结肠炎造瘘术后关瘘时机的选择

目的 多数具有手术指征的新生儿坏死性小肠结肠炎（NEC）患儿需要行坏死肠管切除+肠造瘘术。而对于术后多长时间关闭造瘘口较为合适,目前尚无共识。因此,本研究的目的是明确NEC造瘘术后关瘘的理想时机。方法 本研究回顾性分析了深圳市儿童医院新生儿外科2010年8月至2019年1月之间因NEC行坏死肠管切除+肠造瘘术并在术后一段时间后行关瘘术的患儿资料。为便于分析,我们将早期关瘘（EC）定义为造瘘术后8周内（含8周）,而晚期关瘘（LC）定义为造瘘术后8周后。结果 在58例患儿中,男35例,女23例。手术指征为气腹40例、保守治疗无法控制的感染18例,其中27例为早期关瘘（EC）,31例为晚期关瘘（LC）。关瘘术后EC组有18例患儿需要呼吸机支持（66.67%）,而LC组为10例（32.26%）（P<0.05）;EC组比LC组需要更长时间肠外营养支持;而且EC组的住院时间远高于LC组;共有13例患儿因粘连性肠梗阻的并发症接受了再次手术（其中EC组7例,LC组6例）;4例EC组患儿术后出现切口愈合不良,2例EC患儿因败血症死亡,1例EC患儿因短肠综合征和严重的营养不良死亡,而LC组患儿术后切口均恢复良好,无一例死亡。结论 本研究提示,NEC肠造瘘术后晚期关瘘比早期关瘘能为患儿带来更大的益处。     

Collis联合胃底折叠术治疗儿童先天性食管下段狭窄二例

目的总结Collis联合胃底折叠术治疗2例儿童先天性食管下段狭窄的诊治体会。方法 2015年12月及2016年6月收治2例先天性食管下段狭窄男性患儿,年龄均为2岁;均有反复呕吐史,伴营养不良。其中1例因重度营养不良行胃造瘘术,8个月后行该次手术。术前2例均行食管下端球囊扩张1次无效。行Collis术联合胃底折叠术,同时行幽门成形。结果 2例手术均顺利完成,手术时间分别为120、180 min,术中出血量15、20 mL。狭窄段组织病理检查提示为异位气管支气管软骨。术后1周上消化道造影示吻合口无狭窄及漏,无明显胃食管反流。2例患儿均获随访,均开始进普食,无吞咽困难;体质量较术前明显增加。术后6个月上消化道造影检查示吻合口通畅。结论 Collis联合胃底折叠术是治疗儿童先天性食管下段狭窄的一种较好方法,合理的手术方案设计和手术精细化操作,可以减少术后并发症。     

股薄肌转移修补复杂直肠阴道（尿道）瘘的前瞻陛研究

目的评估股薄肌转移修补治疗复杂直肠阴道（尿道）瘘的临床疗效。方法前瞻性收集2009年5月至2011年11月间在北京世纪坛医院接受股薄肌转移修补治疗的19例复杂直肠阴道（尿道）瘘患者的临床资料。记录修补成功率和手术并发症,并于术前及术后6个月分别进行SF-36生活质量评分、Wexner肛门失禁评分及女性性功能评分。结果19例患者中男性8例（直肠尿道瘘）,女性11例（直肠阴道瘘）。术前修补0-3（平均1．0）次,瘘口直径0．5～2．5（平均1．6）cm,均位于肛门括约肌上方。手术时间145。400（中位240）min,术后住院时间10。39（中位21）d。术后近期出现大腿麻木疼痛2例,小腿麻木2例;无远期并发症出现。术后随访6-35（中位18）个月,修补成功率94．7％（18／19）。术后6个月时。19例患者的Wexner评分由术前10．0±8．8降为2．9±5．8,控粪功能显著改善（P=0．002）;11例女性患者的性功能评分由术前的1．0±1．8升高至4．0±4．0。性功能显著改善（P=0．022）;SF-36生活质量评分显著提高（P〈0．001）。结论股薄肌转移修补治疗复杂直肠阴道（尿道）瘘成功率高,并发症少而轻微,疗效确切。     

足疗佐治小儿脑性瘫痪的效果观察

目的 探讨不同年龄不同类型脑性瘫痪患儿应用中草药足疗的康复效果。方法 将776例脑性瘫痪患儿随机分为对照组（376例）和观察组（400例），两组均采用手法按摩、药物治疗、功能训练等综合治疗；观察组在此基础上辅以中草药足疗。结果 观察组疗效显著优于对照组（P〈0．01）；≤12个月的患儿其疗效优于～36个月的患儿（P〈0．05）；痉挛型患儿疗效显著优于其他型（均P〈0．01）。结论 中草药足疗可明显改善患儿的运动功能，且年龄越小，疗效越显著。     

Stereotactic neuroendoscopic management of hydrocephalus: a three-year follow-up and analysis of Malaysian children with aqueduct stenosis

The beneficial effects of stereotactic third ventriculostomy versus ventriculoperitoneal shunt were evaluated in 62 paediatric patients and analysed in relation to age, sex, clinical history, presence of meningomyelocele, magnetic resonance imaging measurements of hydrocephalus and third ventricle floor size. The third ventriculostomy were done on 50 patients using the Richard-Wolf Caemaert Endoscope and the Leksell Stereotactic Frame Model G. These patients were operated using the 4-French Fogarty catheter to open the base of the third ventricle. During the same period of study 12 paediatric patients with aqueduct stenosis who were managed by ventriculoperitoneal shunt were included. Both surgical procedures were compared. Statistically univariate analysis revealed that those patient with an age group of more than six months undergoing ventriculostomy had good outcome. Multivariate analysis revealed that past history of haemorrhage and/or meningitis were predictors of poor outcome. Sex, size of lumbar meningocele at birth, abnormal ventricular anatomy or narrow third ventricular floor size were non predictors of bad outcome in these patients. There was no difference in outcome in both the shunt or ventriculostomy group.     

Changes in ventricular size after endoscopic third ventriculostomy

Summary Background. There is general consensus that a successful endoscopic third ventriculostomy is usually followed by a decrease of ventricular size without reaching their normal size. This study was performed to determine how the change related to clinical outcome, how it developed chronologically and whether the change in ventricular size was different in acute and chronic forms of hydrocephalus. Method. Fifty-five of 74 patients who had undergone endoscopic third ventriculostomy during the period 1997–2004 were selected by the criterion that they had both pre-operative and post-operative films and no neurosurgical manoeuvre other than a surgically successful endoscopic third ventriculostomy in the time span between both radiological studies. Ventricular size was measured with the Evans index, third ventricle index, cella media index and ventricular score. Median age was 51 years (interquartile range, 27–65 years). Results. The change in ventricular size detected shortly after surgery is related to clinical outcome for all ventricular ratios, except the cella media index (p = 0.08). When third ventriculostomy is clinically successful, there is a gradual decrease of ventricular size over a period of more than three months (p < 0.0001 for all ventricular ratios). The reduction is more prominent in acute hydrocephalus than in chronic forms for all ventricular ratios, except the Evans index (p = 0.12). The third ventricle exhibits the greatest reduction (25% with a 95% confidence interval: 15.4–34.5) and determines a different pattern of change in ventricular size after endoscopic third ventriculostomy between acute and chronic hydrocephalus. Conclusions. A decrease of the ventricular size detected soon after endoscopic third ventriculostomy is associated with a satisfactory clinical outcome. This response continues during the first few months after surgery. The reduction is more prominent in acute forms of hydrocephalus. Correspondence: David Santamarta, Servicio de Neurocirugía, Hospital de León, Altos de Nava s/n, 24071 León, Spain.     

Management of hydrocephalus in pediatric patients with posterior fossa tumors: the role of endoscopic third ventriculostomy.

OBJECT: The authors undertook a study to evaluate the effectiveness of endoscopic third ventriculostomy in the management of hydrocephalus before and after surgical intervention for posterior fossa tumors in children. METHODS: Between October 1, 1993, and December 31, 1997, a total of 206 consecutive children with posterior fossa tumors underwent surgery at H?pital Necker-Enfants Malades in Paris. Excluded were 10 patients in whom shunts had been placed at the referring hospital. The medical records and neuroimaging studies of the remaining 196 patients were reviewed and categorized into three groups: Group A, 67 patients with hydrocephalus present on admission in whom endoscopic third ventriculostomy was performed prior to tumor removal; Group B, 82 patients with hydrocephalus who did not undergo preliminary third ventriculostomy but instead received conventional treatment; and Group C, 47 patients in whom no ventricular dilation was present on admission. There were no significant differences between patients in Group A or B with respect to the following variables: age at presentation, evidence of metastatic disease, extent of tumor resection, or follow-up duration. In patients in Group A, however, more severe hydrocephalus was demonstrated (p < 0.01): the patients in Group C were in this respect different from those in the other two groups. Ultimately, there were only four patients (6%) in Group A compared with 22 patients (26.8%) in Group B (p = 0.001) in whom progressive hydrocephalus required treatment following removal of the posterior fossa tumor. Sixteen patients (20%) in Group B underwent insertion of a ventriculoperitoneal shunt, which is similar to the incidence reported in the literature and significantly different from that demonstrated in Group A (p < 0.016). The other six patients (7.3%) were treated by endoscopic third ventriculostomy after tumor resection. In Group C, two patients (4.3%) with postoperative hydrocephalus underwent endoscopic third ventriculostomy. In three patients who required placement of CSF shunts several episodes of shunt malfunction occurred that were ultimately managed by endoscopic third ventriculostomy and definitive removal of the shunt. There were no deaths; however, there were four cases of transient morbidity associated with third ventriculostomy. CONCLUSIONS: Third ventriculostomy is feasible even in the presence of posterior fossa tumors (including brainstem tumors). When performed prior to posterior fossa surgery, it significantly reduces the incidence of postoperative hydrocephalus. The procedure provides a valid alternative to placement of a permanent shunt in cases in which hydrocephalus develops following posterior fossa surgery, and it may negate the need for the shunt in cases in which the shunt malfunctions. Furthermore, in patients in whom CSF has caused spread of the tumor at presentation, third ventriculostomy allows chemotherapy to be undertaken prior to tumor excision by controlling hydrocephalus. Although the authors acknowledge that the routine application of third ventriculostomy in selected patients results in a proportion of patients undergoing an "unnecessary" procedure, they believe that because patients' postoperative courses are less complicated and because the incidence of morbidity is low and the success rate is high in those patients with severe hydrocephalus that further investigation of this protocol is warranted.     

神经内镜辅助下松果体区表皮样囊肿的手术治疗

目的 探讨神经内镜辅助下松果体区表皮样囊肿的手术效果及脑功能保护.方法 采用枕下幕上入路,在显微镜下切除大部分肿瘤,再辅助神经内镜切除残余肿瘤,配合软镜观察第三脑室及中脑导水管等结构,清除脑室内凝血块及漂浮物.结果 4例肿瘤成功全切,被肿瘤侵蚀或包绕的血管、神经及脑干等结构保护良好；1例因肿瘤包膜与大脑内静脉粘连,残余部分电灼后未全切.术中出血量180 ～400 ml,平均316 ml;手术时间138 ～330 min,平均253.6 min.术后无菌性脑膜炎1例(复发性胆脂瘤),抗生素及腰穿置管后治愈；1例术后2周发生迟发性脑积水,行第三脑室底造瘘术后症状改善；术后无迟发性脑出血.5例随访3 ～12个月,平均5.8月,无复发肿瘤.结论 神经内镜辅助下松果体区胆脂瘤切除术,可以多角度环视病变,指导肿瘤切除.     

Clinical features in patients requiring reoperation after failed endoscopic procedures for hydrocephalus.

The aim of this study was to clarify the clinical features of patients at risk of secondary obstruction following endoscopic fenestration. Clinical notes and endoscopic findings for 15 patients treated with endoscopic procedures were retrospectively reviewed. Endoscopic third ventriculostomy (ETV) was performed as initial treatment in 4 patients with non-communicating hydrocephalus, including a neonate with myelomeningocele, and as an alternative to shunt revision in 4 patients. Two patients with non-communicating hydrocephalus caused by tumor or arachnoid cyst were also managed with third ventriculostomy. Four patients with loculated hydrocephalus underwent endoscopic septostomy. A child with an isolated fourth ventricle was treated with endoscopic aqueductoplasty. Of the 15 patients undergoing endoscopic procedure, 4 required reoperation. Of the 10 patients treated with ETV, only the neonate with myelomeningocele required a ventriculoperitoneal shunt because of failure of the initial procedure. Of the 4 patients treated with endoscopic septostomy, 2 children with loculated hydrocephalus following intraventricular hemorrhage (IVH) underwent a second septostomy. In a patient with an isolated fourth ventricle following posthemorrhagic hydrocephalus, recurrence was noted 8 months after the initial procedure. He underwent a second procedure using a stent implanted into the aqueduct to maintain CSF circulation. Sufficient stomal size or implantation of a stent may be required in the under-2-year age group with hydrocephalus accompanied by IVH and associated with myelomeningocele, in whom the risk of secondary obstruction may be high.     

Endoscopic third ventriculostomy for chronic hydrocephalus after tuberculous meningitis

BACKGROUND: Cerebrospinal fluid diversion procedures are indicated in patients with hydrocephalus after tuberculous meningitis (TBM). We present 2 patients with hydrocephalus after TBM who were successfully treated with endoscopic third ventriculostomy (ETV). METHODS: Two patients had been diagnosed with hydrocephalus after TBM and had undergone ventriculoperitoneal shunt surgery for the same. They presented with multiple episodes of shunt dysfunction. Endoscopic third ventriculostomy was performed (twice for one patient), and the patients were evaluated clinically and radiologically after the procedure. RESULTS: On long-term clinical follow-up (3 and 2 years, respectively), both patients were asymptomatic after the ETV. The first patient was radiologically evaluated 7 months after the procedure and the second patient 2 years after the procedure. The first patient showed a decrease in ventricular size. The second patient did not show any significant change in the ventricular size. CONCLUSION: Endoscopic third ventriculostomy can be considered as a safe and long-lasting solution for hydrocephalus after chronic TBM.     

Traumatic subependymal hematoma during endoscopic third ventriculostomy in a patient with a third ventricle tumor: case report.

Endoscopic third ventriculostomy has become a routine intervention for the treatment of non-communicating hydrocephalus. This technique is largely considered safe and a very low incidence of complications is reported. However, hemorrhage in the course of neuroendoscopy is still a problem difficult to manage. The authors present a case in which endoscopic third ventriculostomy and tumor biopsy were performed in a young patient with a huge tumor growing in the posterior part of the third ventricle. The surgical approach to realize the stoma was difficult because the tumor size reduced the third ventricle diameter. Surgical manipulation produced a traumatic subependymal hematoma. This hematoma drained spontaneously after few minutes into the ventricle and the blood was washed away. The postoperative neurological course was uneventful and the ventriculostomy showed to work well by reducing the size of the lateral ventricles and the intracranial pressure in three days. This complication during endoscopic third ventriculostomy has never been reported before. We emphasize the difficulty of endoscopic procedures in patients with huge tumors in the third ventricle. Where reduction in size of the third ventricle and of the foramen of Monro ist present we suggest a careful approach to the third ventricle.     

Ventricular volume following third ventriculostomy.

OBJECT: Ventricular size often shows no obvious change following third ventriculostomy, particularly in the early postoperative period, making postoperative evaluation difficult without expensive and often invasive testing in patients with equivocal clinical responses. The authors hypothesized that performing careful volumetric measurements would show decreases in size within the first 3 weeks after surgery. METHODS: Volumetric measurements were calculated from standard 3 x 3-mm axial computerized tomography (CT) scans obtained immediately before and 3 and 21 days after surgery. Two independent investigators measured third ventricular volume in a series of 16 patients and lateral ventricular volume in 10 of the patients undergoing stereotactically guided endoscopic third ventriculostomy for noncommunicating hydrocephalus. Fifteen patients were symptomatically improved at the time the follow-up scan was obtained. Third ventricular volume decreased in all patients by a mean of 35% (range 7.8-95.1%) and lateral ventricular volume decreased in all patients by a mean of 33% (range 4.5-80.3%). The degree of change correlated with the length of preoperative symptoms (p < 0.005). The one patient who experienced no improvement showed no decrease in third ventricular volume. In seven of 10 patients, the decrease in third ventricular volume exceeded the decrease in lateral ventricular volume. Repeated measurements indicated that the 95% confidence interval for the authors' calculations varied around the mean by 2.5% for third ventricular volume and 1.2% for lateral ventricular volume. Long-term outcome was excellent, with only one case of delayed failure. The mean follow-up duration was 12 months. CONCLUSIONS: Volumetric measurements calculated from standard CT scans will show a demonstrable decrease in ventricular volume soon after successful third ventriculostomy and can be helpful in assessing patients postoperatively. Although the third ventricle may exhibit a greater decrease, the lateral ventricular measurements are more accurate. Patients with more indolent symptoms show the smallest change.     

Endoscopic third ventriculostomy is the treatment of choice for obstructive hydrocephalus due to pediatric pineal tumors.

Pineal lesions in the pediatric patient are often complicated by the development of hydrocephalus due to obstruction of the aqueduct or the third ventricle by tumor masses. In such cases, hydrocephalus treatment has the highest priority and should be performed prior to any surgical treatment of the pineal tumor itself. The golden standard in obstructive hydrocephalus treatment remains placement of a temporary or permanent cerebrospinal fluid shunt, although there are many long-term complications associated with a shunt system. To avoid these and to render the patients independent from a failure-prone shunt system, we employed endoscopic third ventriculostomy for permanent relief of elevated intracranial pressure prior to surgical removal of the pineal lesions. The present study summarizes the results of this approach in 7 pediatric patients with obstructive hydrocephalus. No complications of the endoscopic procedure were encountered, and the ventriculostomy remained patent in all cases, as confirmed by motion sensitive MRI. The advantages of endoscopic third ventriculostomy as compared with other techniques are discussed, and its increasing role in the management of children with space occupying lesions of the pineal region is defined.     

Elastance correlates with outcome after endoscopic third ventriculostomy in adults with hydrocephalus caused by primary aqueductal stenosis

OBJECTIVE: To study prospectively the correlation between clinical outcome after endoscopic third ventriculostomy (ETV) and resistance to the outflow of cerebrospinal fluid (R(out)) and elastance in adults with hydrocephalus caused by primary aqueductal stenosis (AS). METHODS: R(out) and elastance were measured in the subarachnoid space and intraventricularly before ETV in 15 consecutive patients. Three months after the ETV, the clinical effect was evaluated by standardized indices, and R(out) and elastance were measured. If symptoms persisted and the ETV was patent, shunt surgery was offered. The effect of the shunt operation and R(out) were measured after 3 months. RESULTS: Four patients experienced excellent improvement, six improved slightly, and five had unchanged or deteriorated symptoms after ETV. R(out) before ETV did not correlate with outcome. R(out) decreased after ETV with correlation to the clinical effect; in the six patients who had shunt surgery, R(out) decreased further. High preoperative elastance correlated strongly with a good outcome and reduction of ventricle size. Elastance did not change after ETV. CONCLUSION: R(out) intraventricularly and in the subarachnoid space could not predict the outcome of the ETV, but the reduction in R(out) correlated positively with clinical improvement. Preoperative elastance correlated positively with clinical improvement, and elastance was unchanged after ETV. Clinical improvement correlated positively with reduction in ventricle size.