DOI: https://doi.org/10.53350/pjmhs22169391 ORIGINAL ARTICLE P J M H S Vol. 16, No. 09, September, 2022 391 Surgical Outcomes of Third Ventriculostomy in Patients of Obstructive Hydrocephalus SOHAIB ALI 1 , TAUSEEF ULLAH 2 , MUHAMMAD IBRAHIM AFRIDI 3 , TABRAIZ WALI SHAH 4 , SHAFIQ UR REHMAN 5 , HANIF UR RAHMAN 6 , IDRIS KHAN 7 , MUHAMMAD TAIMUR KHAN 8 , EHSAN SAYYED 9 1,2,3 Department of Neurosurgery, Hayatabad Medical Complex, Peshawar. PGR Neurosurgery 4 Department of Neurosurgery, Hayatabad Medical Complex. PGR Neurosurgery 5 Department of Neurosurgery, Hayatabad Medical Complex, Peshawar. PGR Neurosurgery 6 Assistant Professor Neurosurgery Department of Neurosurgery, Prime Teaching Hospital, Peshawar. 7 Department of Neurosurgery, Khyber Teaching Hospital, Peshawar. Professor Neurosurgery, HOD Neurosurgery 8 Department of General surgery, Hayatabad Medical Complex, Peshawar. PGR General Surgery 9 Department of Anatomy, Nowshera Medical College, Nowshera. Lecturer Corresponding author: Muhammad Ibrahim Afridi, Email: miafridi8@gmail.com ABSTRACT Introduction: Hydrocephalus is the accumulation of excess cerebrospinal fluid (CSF) in the ventricular system of the brain. Objectives: The main objective of this study is to find the surgical outcomes of third ventriculostomy in patients of obstructive hydrocephalus. Material and methods: The data was collected through non-probability consecutive sampling technique. There were 60 patients which were included in the study. A flexible endoscopic telecamera and a Bugbee electrocautery wire and monitor were used for the procedure. The main causes of hydrocephalus have been identified. history of meningitis, ventriculitis, or illness prior to the development of hydrocephalus; x-rays indicating separation or septa within the ventricles; or postoperative residue of hemosiderin or the presence of yellowish deposits were all taken into consideration of post infectious hydrocephalus. Results: There were 49 male and 11 female patients. The mean age of the patients was 39.38 ± 11.2 years. 27 (45%) patients had hydrocephalus due to tumors, 21 (35%) patients had aqueductal stenosis while 12 (20%) patients had benign cysts. Intraoperative bleeding occurred in 24 patients. ETV was successful in 54/60 – 90percent of the patients. A CSF leak was recognised in 09 patients. 07 patient developed a transient gaze palsy which had resolved when he came for his follow up visit on 10th post operative day. Practical implication: Use effective method for treatment of hydrocephalus in hospitals Conclusion: It is concluded that endoscopic third ventriculostomy, in general, is a very effective method of treatment for hydrocephalus. Keywords: Obstructive Hydrocephalus, ETV, Outcome, CSF, Brain, Ventricular INTRODUCTION Hydrocephalus is the accumulation of excess cerebrospinal fluid (CSF) in the ventricular system of the brain. The causes can be obstructive or non-obstructive in nature. Obstructive reasons consist of space-occupying lesions, congenital lesions, and so forth. Non-obstructive causes include infection, bleeding 1 . Placement of a ventriculoperitoneal shunt is the standard remedy, however contamination and blockage of the shunt are common complications. An alternative to ventriculoperitoneal shunt is endoscopic ventriculostomy (ETV) 2 . the extended time period that the shunt is in situ can lead to infection of the implant system and even bloackage. Patients may be treated without considerable morbidity using intracranial CSF diversion, i.e ventriculostomy. This technique uses the introduction of the endoscope through a burr hole created just anterior to coronal suture in mid pupillary line, that is completed by making a window in floor of the third ventricle, communicating the cisternal spaces with the ventricular system. Ventriculostomy, first advocated by Dandy, was deserted in want of extracranial strategies 3 . Endoscopic ventriculostomy revolutionized the treatment of hydrocephalus. It drains cerebrospinal fluid (CSF) from the ventricle into the prepontine cistern, bypassing the nidus of obstruction 4 . This system is performed through use of an endoscope with proper lighting fixtures, magnification, and a monitor. It requires a know-how in coping with the endoscopic vision and orientation to endoscopic anatomy. Awareness and white stability are checked earlier before proceeding. One Bur hole is created in the Kocher tip. within the frontal horn, the thalamostriatal vein is used as a route to the foramen of monro 5 . A stoma is created inside the floor of the third ventricle, which permits flow between the ventricle and the prepontine cistern. The procedure gained interest with upgrades in endoscopic era in 1970s. It has low complication rate and does not contain any implant. common complications are bleeding, leakage of cerebrospinal fluid, infection, seizures and failure of the procedure. Minor bleeding is treated with non-stop irrigation, focal strain or cauterization 6 . The incidence of hydrocephalus follows a bimodal age curve. One peak occurs at some stage in childhood and is related to congenital abnormalities. every other onslaught comes in maturity, that's primarily because of NPH. Adult hydrocephalus accounts 40% of all hydrocephalus instances. Although a great deal has been found out about the lengthy-term and social outcomes of pediatric hydrocephalus, there's nevertheless a good deal to research. Hydrocephalus is commonplace in people with open neural tube defects (spina bifida cystica), however has only been suggested in human beings with closed neural tube abnormalities (spina bifida occulta) 7 . due to this unusual however possible affiliation, it's recommended that people with closed neural tube abnormalities be investigated for clinical signs and symptoms of hydrocephalus 8 . ETV has lately received recognition amongst neurosurgeons. it is useful for patients with obstructive hydrocephalus and in cases of repeated shunt failures for other causes. ETV is the treatment of choice in instances of hydrocephalus, because it eliminates the necessity for a shunt 9 . Within the last few years, vast advances in neuroimaging, endoscopic technology, processing device, and stereotactic neuronavigation systems have led to the large use of endoscopy for some of interventions, particularly obstructive hydrocephalus as well as some selected non-obstructive hydrocephalus cases 10 . Even though ETV has already been identified as an alternative to shunt placement, in particular in young patients with noncommunicating hydrocephalus, its efficacy stays questionable relying at the age and pathophysiology of the hydrocephalus 11 . MATERIAL AND METHODS The study data was collected from 1 st Oct to 1 st Nov 2022, in the departments of Neurosurgery of Hayatabad Medical complex, Khyber Teaching Hospital, Lady Reading Hospital, Peshawar. The