SURGICAL TREATMENT OF OCCLUSIVE HUDROCEPHALIA INFANTS USING OF ENDOSCOPIC THIRD VENTRICULOCISTERNOSTOMY

Abstract

To improve the outcome of surgical treatment of occlusive hydrocephalus in infants by introducing an endoscopic ventriculocisternostomy in the third ventricle (ETV III).

Material and methods. We studied the results of a comprehensive examination and surgical treatment of 16 children aged from 28 days to 1 year who were admitted for inpatient treatment during 2021/23, to the department of Pediatric Neurosurgery of SI NMC RT "Shifobakhsh", which is the clinical base of the department of Neurosurgery and Combined Trauma of SEI of Avicenna Tajik state medical university. All examined children were diagnosed with internal progressive occlusive hydrocephalus. In all cases, the children underwent clinical and neurological examination. The observed patients underwent CT and MRI studies, as well as neuro-ophthalmoscopy. All patients underwent minimally invasive intervention of endoscopic ventriculocisternostomy of the fundus of the third ventricle (ETV III). Postoperative follow-up period ranged from 3 months to 1.5 years.

Results. The use of the minimally invasive ETV III technique in the surgical treatment of occlusive hydrocephalus in infants made it possible to significantly reduce the time of surgical intervention and the postoperative period of the patient's stay in the hospital. At the same time, the creation of artificial pathways for ventriculosubarachnoid CSF outflow reduced the use of traditional methods of surgical treatment, such as LShO, and the complications associated with this technique. All patients (100%) had cerebral symptoms, hypertensive-hydrocephalic syndrome. Positive results were achieved in 12 patients (75%), one patient (6.25%) had a complication in the form of a subdural hematoma of small volume, which spontaneously resolved. In one patient (6.25%), the stoma did not function during the period of stay in the hospital, and in 2 (12.5%) the formed hole closed in the first month after the operation due to exacerbation of ventriculitis.

Conclusions. The use of ETV III in the surgical treatment of occlusive hydrocephalus is a minimally invasive surgical technique that can reduce the time of intervention, reduce trauma and postoperative complications. It can be considered as an alternative to traditional bypass surgery in children with CSF occlusion.