Tercer ventriculostomía endoscópica: mecanismos de fracaso y consideraciones sobre re fenestración o colocación de shunt / Endoscopic III ventriculostomy: Mechanisms of failure and considerations about refenestration of shuting

ABSTRACT

Objective: To evaluate retrospectively, a group of patients of our series, that had a failed ventriculostomy to try to determine the causes and the treatement offered to them. Material and method: 140 ETVs were performed in 132 patients; 120 of them are shunt free (90.90). Eight patients (5.71) showed closure of the ventriculostomy in 4, it was presumed to be related to postoperative radiotherapy; 2 patients had an insufficient opening of the Lilliequist membrane and 2 showed ostoma closure of origin. In all of them a second ETV was performed, and the procedure was successful. Twelve patients (8.57) required shunt placement; 4, with a history of septated postmeningitis hydrocephalus, now only need a single ventricular catheter. Of the remaining, 3 presented with meningeal seeding from malignant tumors; 1 with racemous neurocysticerosis, 1 with multiple malformations and history meningitis; 2 with a previously unknown aresorptive component; 1 with history of post- shunt meningitis. Most patients with ETV failure developed CSF fistula. In all these cases, patency of the ostoma was confirmed during re-exploration, and consequently, a shunt was indicated. Discussion and conclusion: We consider ETV to be the standard treatment for obstructive hydrocephalus. With low morbidity in our series (4.68) and no mortality. Re-exploration and eventual re-fenestration are indicated in al cases of ETV failure, given the benefits of shunt independence.