Download PDF
Minim Invasive Neurosurg 2006; 49(4): 238-243
DOI: 10.1055/s-2006-950382
Original Article

© Georg Thieme Verlag KG · Stuttgart · New York

Outcome Prediction of Third Ventriculostomy: A Proposed Hydrocephalus Grading System

U. Kehler 1 , J. Regelsberger 2 , J. Gliemroth 3 , M. Westphal 2
  • 1Neurosurgical Department, Asklepios Clinic Altona, Hamburg, Germany
  • 2Neurosurgical Department, University Hospital Hamburg Eppendorf, Germany
  • 3Neurosurgical Department, Medical University Schleswig-Holstein, Lübeck, Germany
Further Information

Publication History

Publication Date:
13 October 2006 (online)

    Permissions and Reprints

Abstract

An important factor in making a recommendation for different treatment modalities in hydrocephalus patients (VP shunt versus endoscopic third ventriculostomy) is the definition of the underlying pathology which determines the prognosis/outcome of the surgical procedure. Third ventriculostomies (3rd VS) are successful mainly in obstructive hydrocephalus but also in some subtypes of communicating hydrocephalus. A simple, easily applicable grading system that is designed to predict the outcome of 3rd VS is proposed. The hydrocephalus is graded on the basis of the extent of downward bulging of the floor of the third ventricle, which reflects the pressure gradient between the 3rd ventricle and the basal cisterns, presence of directly visualised CSF pathway obstruction in MRI, and the progression of the clinical symptoms resulting in five different grades. In this proposed grading system, grade 1 hydrocephalus subtype shows no downward bulged floor of the 3rd ventricle, no obstruction of the CSF pathway, and no progressive symptoms of hydrocephalus. There is no indication for 3rd VS. Grades 2 to 4 show different combinations of the described parameters. Grade 5 subtype shows a markedly downward bulged floor of the 3rd ventricle and direct detection of the CSF pathway obstruction (i.e., aqueductal stenosis) with progressive clinical deterioration. Retrospective application of this grading scheme to a series of 72 3rd VS has demonstrated a high correlation with the outcome: The success rate in grade 3 reached 40%, in grade 4: 58%, and in grade 5: 95%. This standardised grading system predicts the outcome of 3rd VS and helps in decision making for 3rd VS versus VP shunting.

Key words

Third ventriculostomy - hydrocephalus - grading system - prognosis

References

  • 1 Cohen AR. Cranial endoscopy illustrative case.  Techniques in Neurosurg. 1995;  1 144-147
    PubMedGoogle Scholar
  • 2 Kehler U, Gliemroth J. Extraventricular intracisternal obstructive hydrocephalus-A hypothesis to explain successful 3rd ventriculostomy in communicating hydrocephalus.  Pediatric Neurosurg. 2003;  38 98-101
    CrossrefPubMedGoogle Scholar
  • 3 Kestle J, Cochrane D, Alisharan R. The initial treatment of hydrocephalus: an assessment of surgeons' preference between third ventriculostomy and shunt insertion.  Neurol Res. 2000;  22 65-68
    PubMedGoogle Scholar
  • 4 Drake JM. Ventriculostomy for treatment of hydrocephalus.  Neurosurg Clin North Am. 1993;  4 657-666
    PubMedGoogle Scholar
  • 5 Hirsch JF. Percutaneous ventriculocisternostomies in non-communicating hydrocephalus.  Monogr Neurol Sci. 1982;  8 170-178
    PubMedGoogle Scholar
  • 6 Hopf NJ, Grunert P, Fries G, Resch KDM, Perneczky A. Endoscopic third ventriculostomy: outcome analysis of 100 consecutive procedures.  Neurosurg. 1999;  44 795-806
    CrossrefPubMedGoogle Scholar
  • 7 Jones RFC, Teo C, Stening WA, Kwok BCT. Neuroendoscopic third ventriculostomy. In: Manwaring KH, Crone KR (eds): Neuroendoscopy. Mary Ann Liebert, Inc., Publishers, New York Vol 1 1992: 63-77
    Google Scholar
  • 8 Kelly PJ. Stereotactic third ventriculostomy in patients with nontumoral adolescent/adult onset aqueductal stenosis and symptomatic hydrocephalus.  J Neurosurg. 1991;  75 865-873
    CrossrefPubMedGoogle Scholar
  • 9 Kunz U, Goldmann A, Bader C, Waldbaur H, Oldenkott P. Endoscopic fenestration of the 3rd ventricular floor in aqueductal stenosis.  Minim Invas Neurosurg. 1994;  37 42-47
    PubMedGoogle Scholar
  • 10 Sainte-Rose C. Third ventriculostomy. In: Manwaring KH, Crone KR (eds): Neuroendoscopy. New York: Mary Ann Liebert Vol 1 1992: 47-62
    Google Scholar
  • 11 Teo C. Third ventriculostomy in the treatment of hydrocephalus: experience with more than 120 cases. In: Hellwig D, Bauer BL (eds): Minimally Invasive Techniques for Neurosurgery. Springer Verlag, Berlin, Heidelberg, Berlin 1998: 73-76
    Google Scholar
  • 12 Korinth M, Bertalanffy H, Rhode V, Bassiouni H, Glisbach JM. Reduzierung der Shuntpflichtigkeit durch Eröffnung der Lamina terminalis bei Patienten mit rupturierten intrakraniellen Aneurysmen.  Zentralbl Neurochir. 1996;  70 ((Suppl)) , (abstract)
    PubMedGoogle Scholar
  • 13 Meier U, Zeilinger FS, Schonherr B. Endoscopic ventriculostomy versus shunt operation in normal pressure hydrocephalus: diagnostics and indication.  Minim Invas Neurosurg. 2000;  43 87-90
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Tomasllo F, d'Avella D, de Divitiis O. Does lamina terminalis fenestration reduce the incidence of chronic hydrocephalus after subarachnoid hemorrhage?.  Neurosurgery. 1999;  45 827-831
    PubMedGoogle Scholar
  • 15 Barlow P, Ching HS. An economic argument in favour of endoscopic third ventriculostomy as a treatment for obstructive hydrocephalus.  Minim Invas Neurosurg. 1997;  40 37-38
    PubMedGoogle Scholar
  • 16 Kehler U, Gliemroth J, Wagner R, Arnold H. 3rd ventriculostomy versus ventriculoperitoneal shunt. An analysis of results, complications, and costs.  Zentralbl Neurochir. 1996;  84 ((Suppl)) , (abstract)
    PubMedGoogle Scholar
  • 17 Handler MH, Abbott R, Lee M. A near-fatal complication of endoscopic third ventriculostomy: case report.  Neurosurg. 1994;  35 525-527
    CrossrefPubMedGoogle Scholar
  • 18 McLaughlin MR, Wahlig JB, Kaufmann AM, Albright AL. Traumatic basilar aneurysm after endoscopic third ventriculostomy: case report.  Neurosurgery. 1976;  41 1400-1403
    PubMedGoogle Scholar
  • 19 Benabarre A, Ibánez J, Boget T, Obiols J, Martinéz-Aran A, Vieta E. Neuropsychological and psychiatric complications in endoscopic third ventriculostomy: a clinical case report.  J Neurol Neurosurg Psychiatry. 2001;  71 268-271
    CrossrefPubMedGoogle Scholar
  • 20 Schroeder HW, Niendorf WR, Gaab MR. Complications of endoscopic third ventriculostomy.  J Neurosurg. 2002;  96 1032-1040
    PubMedGoogle Scholar
  • 21 Schroeder HW, Warzok RW, Assaf JA, Gaab MR. Fatal subarachnoid hemorrhage after endoscopic third ventriculostomy.  Case report. J Neurosurg. 1999;  90 153-155
    CrossrefPubMedGoogle Scholar

Correspondence

Prof. Dr. Uwe Kehler

Department of Neurosurgery·Asklepios Clinic Altona

Paul-Ehrlich-Str. 1

22763 Hamburg

Germany

Phone: +49/40/18 18 81/1671

Fax: +49/40/18 18 81/4911

Email: uwe.kehler@ak-altona.lbk-hh.de

      >