Shams Raza Brohi, Ali Raza Brohi, Muzamil Dilber.
Neuroendoscopic management of hydrocephalus and associated intracranial lesions.
J Surg Pak Jan ;17(2):72-5.

Objective: To document the experience of intraventricular neuroendoscopy in the diagnosis and management of intracranial lesions causing hydrocephalus as well as endoscopic third ventriculostomy (ETV) in treating hydrocephalus. Study design: Descriptive case series. Place & Duration of study: Department of Neurosurgery, Peoples University of Medical and Health Sciences Nawabshah, from January 2009 to June 2011. Methodology: Patients of hydrocephalus associated with intracranial lesions were enrolled. Lesions were resected using endoscopic approach or by microsurgical technique. Extra-axial lesions causing obstructive hydrocephalus were managed with microsurgical resection and ETV. Endoscopic third ventriculostomy was performed for persistent hydrocephalus. Results: The study population consisted of 20 patients (13 males - 65% and 7 females - 35%). The age ranged from 6 months to 70 year with the mean age of 21.6 year. Colloid cysts (n=2) and cystic craniopharyngioma (n=1) in third ventricle were completely excised. Third ventricular ependymoma was partially excised and referred for radiotherapy. Hydrocephalus was treated by ETV in 10 cases (50%), complete resection of the intraventricular lesions in 3 (15%) cases and ventriculoperitoneal (VP) shunt placement in 7 (35%) cases. VP shunt was avoided in 13 (65%) cases. Conclusions: ETV is an effective method of treating hydrocephalus associated with intracranial lesions. Intra-cranial extra-axial lesions can be effectively managed with microsurgical method. Intraventricular lesions can be resected or biopsied with neuroendoscopy providing a better minimal access with good illumination. VP shunt can be avoided in most of the cases.

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