Authors' objectives:

The objective of the report was to analyze the usefulness of third ventricle neuroendoscopy for the management of different forms of hydrocephalus.

Authors' results and conclusions: No systematic reviews, controlled clinical trials, coverage policies or health technology agencies reports were found. Narrative reviews, case series, case reports, a cost study case and a cost -effectiveness study reports were used. Its most important indications were reviewed: Obstructive Hydrocephalus As regards long-term effectiveness, some case series with follow-ups longer than five years show more than 70% effectiveness for most indications. Results are comparable to those obtained with ventriculoperitoneal shunts in the pediatric patient series identified, but no comparative studies were found including both forms. About 75% of the procedures that fail do so during the first 6 months after surgery. Children younger than 2 years old show somewhat lower rates of success. Most series report between 7 and 12% of surgical complications. Primary aqueductal stenosis (AS) is the most common indication. In most series, the rate of success was stable, between 63 and 92%. Lactating infants needed longer periods to adapt to ETV. In AS secondary to tumors, several small pediatric series report over 65% effectiveness at one-year follow-up, though this is lower if the tumor is malignant. In 66 procedures performed to children under 2, the rate of success was 53%, which is lower to that reported in the literature for elder patients. In a series of 66 adults treated with ETV, the cause was tumoral in 59%, and primary aqueductal stenosis in 41%. Seventy one percent of the cases presented the acute form. The likelihood of having an ETV that continued working at 5.7 years was 71.6% (95% CI 60.5 to 82.8) Failures, generally acute, occurred in 27.3%. For the treatment of tectal, pineal and posterior fossa tumors, successful results are also reported. About 20 to 75% of premature newborns with ventricular haemorrhage will develop hydrocephalus. One series of 36 patients reports a 55.6% success at 1.6 years of follow-up. Hematoma aspiration together with ETV can be of great help in the management of this type of obstructive hydrocephalus. Communicating Hydrocephalus This is the most frequent form in adults. Likely causes are infections (meningitis, ventriculitis, tuberculosis), and myelomeningocele. ETV indications have not been well defined yet. Although an overall rate of success of about 60% has been reported, data come from small series with short follow-up periods.

Authors' recommendations: In general, the evidence found is of poor methodological quality since it consists of case series of heterogeneous populations. No controlled trials were identified. For the different indications, the rate of success of ETV seems to be similar to that of ventriculoperitoneal shunts, ranging from 50 to 90%. Its main potential advantage could be the lower need for re-interventions and lower incidence of complications. The procedure is operator-dependant and its cost during the first year seems to be higher than the other alternatives commonly used. The pathologies in which there seems to be more experience are acquired aqueductal stenosis, cysts or infected lesions resulting in obstructions and tumors.

Authors' methods: Overview

Project Status: Completed

URL for project: http://www.iecs.org.ar/

Year Published: 2007

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Argentina

Organisation Name: Institute for Clinical Effectiveness and Health Policy

Contact Address: Dr. Emilio Ravignani 2024, Buenos Aires - Argentina, C1414 CABA

Contact Name: info@iecs.org.ar

Contact Email: info@iecs.org.ar

Copyright: Institute for Clinical Effectiveness and Health Policy (IECS)