Endoscopic third ventriculostomy: towards more indications for the treatment of non-communicating hydrocephalus.

OBJECTIVE: Since its reintroduction during the last 2 decades, third ventriculostomy has shown promising results. However, with more experience and better selection of cases, the indications and contraindications are likely to change. METHODS: During the period from November 1994 to December 1996, we have treated 27 patients with non-communicating hydrocephalus by endoscopic third ventriculostomy at the King Khalid University Hospital. Their ages ranged from 35 weeks preterm to 26 years of age. Sixteen (59%) patients were one year old or younger. Their follow-up ranged from 9 months to 2.5 years. According to the etiology of the non-communicating hydrocephalus, patients were divided into 4 subgroups. These were as follows: 11 aqueduct stenosis, 6 post ventriculitis, 6 cysts, and 4 posterior fossa tumours. The outcome was graded into 3 grades: Grade III were patients who improved after the procedure. Grade II were patients who improved after adding a VP-shunt to the procedure. Grade I were failure patients. RESULTS: An overall outcome of Grade III was achieved in 22 patients (81%). This was broken down according to subgroups as follows: 8/11 (73%) patients of subgroup 1, 5/6 in each of the patients of subgroup 2 and 3, and all of the patients with posterior fossa tumours. DISCUSSION: The overall results were very encouraging and so for the subgroups as compared with the reported cases in the literature. CONCLUSION: Better selection of the cases and increased experience with the procedure is expected to improve the outcome.