[Efficiency of neuroendoscopic operations in achieving shunt independency in hydrocephalus with liquor-shunting system dysfunction].

OBJECTIVE: to evaluate the efficiency of endoscopic treatments in achieving shunt independency in patients with hydrocephalus and shunt dysfunction. SUBJECTS AND METHODS: endoscopic treatment was performed in 28 patients (15 males and 13 females) aged 7.0 +/- 1.2 years (0.5-24 years) with hydrocephalus and CSF shunt dysfunction. The interval between the first shunt implantation and endoscopic surgery (the time of shunt dependency) was 43.4 +/- 7.8 months (5-180 months). All operations were made using the universal Gaab neuroendoscopic system (Karl Storz GmbH and Co., Germany). The follow-up lasted 49.4 +/- 6.9 months (6-120 months). RESULTS: All the patients were successfully operated on, without intraoperative complications and deaths being observed. Surgical interventions were as follows: endoscopic ventriculocisternostomy (n=23), endoscopic aqueductoplasty (n=1), and endoscopic cystoventriculocistemrnostomy (n=4). In 24 of the 28 patients, the symptoms of intracranial hypertension regressed completely. CSF shunt reimplantation was required in 3 cases and prolonged external drainage in 1 case of existing ventriculitis. It should be noted that 24 of the 28 patients became shunt-independent; a shunt was removed in 13.

Neuroendoscopic procedures in achievement of shunt independence: outcome analysis of 28 patients with shunt malfunction.

OBJECTIVE: The authors review their experience of the TV-controlled endoscopic technique in the treatment of shunt malfunction in 28 patients suffering from hydrocephalus. MATERIAL AND METHODS: We treated 28 patients (6.6+/-1.2 years) with shunt malfunctions by a neuroendoscopic procedure. The number of reimplantations of the shunt systems prior to the neuroendoscopic procedure varied from 1 to 13. Duration of the shunt dependency has averaged to 42.7+/-8.1 months (range: 5-180 months). All procedures were performed with the Gaab I neuroendoscope and Gaab II miniature neuroendoscope. All patients presented with neurological signs and deficits. The follow-up period has averaged to 32.3+/-6.2 months (4-114 months). CONCLUSION: Endoscopic surgery offers an effective technique in the surgical treatment of shunt malfunction. On the basis of our experience, the use of a neuroendoscopic procedure for shunt malfunction allows us to achieve shunt independence in 82.1% and shunt removal in 50.0%. The introduction of these methods is recommended in neurosurgical centers that are traditionally widely engaged in the treatment of hydrocephalus.

[The topographic anatomy of the interpeduncular cistern and endoscopic ventriculocisternostomy in the region of the bottom of the third ventricle].

The interpeduncular cistern was microanatomically studied on 14 anatomic specimens of the brain. It was divided into 2 parts: superficial (free) and deep (vascular). The upper interpeduncular cistern wall was divided into hypothalamic and mesencephalic parts. The interpeduncular cistern is connected with the ambient, pretontine, carotid, cerebellopontine, oculomotor, and peduncular cisterns. It is a composite space-occupying, structural formation. Liliequist's membrane is the basic membranous component of a cistern. The proposed division makes it possible to study different parts of the interpeduncular cistern qualitatively and quantitatively and to define clear topographic and anatomic criteria as a guideline in this field.