07/11/12 22:07 The Role of Endoscopic Third Ventriculostomy in the Manageme... : Neurosurgery Pagina 1 di 21 http://journals.lww.com/neurosurgery/Fulltext/1998/12000/The_Role_of_Endoscopic_Third_Ventriculostomy_in.30.aspx Neurosurgery: December 1998 - Volume 43 - Issue 6 - pp 1323-1327 Clinical Studies The Role of Endoscopic Third Ventriculostomy in the Management of Shunt Malfunction Cinalli, Giuseppe MD; Salazar, Cristian MD; Mallucci, Conor MD; Yada, José Zanoni MD; Zerah, Michel MD; Sainte-Rose, Christian MD Author Information Department of Pediatric Neurosurgery, Hôpital Necker-Enfants Malades, Université René Decartes, Paris, France Received, April 16, 1998. Accepted, August 6, 1998. Reprint requests: Giuseppe Cinalli, M.D., Service de Neurochirurgie, Hôpital Necker- Enfants malades, 149 Rue de Sévres, 75015 Paris, France. Abstract OBJECTIVE: To evaluate the effectiveness of third ventriculostomy as an alternative to shunt revision in the management of shunt malfunction and infection in obstructive hydrocephalus. METHODS: All of the clinical notes of 30 patients treated with third ventriculostomy for malfunctioning or infected shunts between January 1, 1974, and December 31, 1996, were retrospectively reviewed. Third ventriculostomy was performed under fluoroscopic control in the first seven patients and endoscopically in the remainder. A successful outcome was achieved if further shunt revision surgery was avoided. The median follow-up duration was 8.7 years RESULTS: Twenty-three patients (76.7%) experienced successful outcomes, resulting in shunt independence. Of the seven failures, three were technical failures at the time of surgery and the remaining four were manifest within a median of 10 days, resulting in shunt revision. There have been no delayed failures. CONCLUSION: Third ventriculostomy is a valuable alternative to shunt revision in patients affected by obstructive hydrocephalus presenting with shunt malfunction or infection. It should be considered in all suitable cases as the first-line treatment for obstructive hydrocephalus of all causes. Because all failures were manifest within a short time, it is likely that these successes will be durable.