[Neuroendoscopy in the treatment of third ventricular hydrocephalus accompanying tumors of the posterior part of the third ventricle in children].

OBJECTIVE

The aim of the study was to evaluate the effectiveness of endoscopic third ventriculostomy (ETV) in non-communicating hydrocephalus secondary to tumour of the posterior part of the third ventricle tumours in children.

MATERIAL AND METHODS

The study group consisted of 32 patients (13 girls and 19 boys) treated at the Department of Neurosurgery Children's Memorial Health Institute in Warsaw in the years 1996-2000. In 22 cases benign tectal mass (BTM) and 10 malignant neoplasms (including 9 germ cell tumours and 1 ependymoma) were diagnosed. The follow-up period after ETV ranged from 5 months to 4 years (mean 21 months). The retrospective analysis of medical reports and control CTs, MRs, and PC MR-cine studies was performed.

RESULTS

In all the patients the early (up to 3 months postop) outcomes were good. 8 patients with malignant neoplasms after initial chemotherapy underwent residual tumor excision (more than 3 months after ETVs) and in two of them the CFS meningeal tumor spreads were detected. In 26 (81%) of the patients permanent control of hydrocephalus was achieved. The recurrence of active hydrocephalus was observed in 6 cases (19%). 3 of them were children with benign tectal masses and 3 with malignant tumours. The reason of failure in 2 cases was associated with meningeal tumor dissemination, and in one with postoperative bleeding after surgical tumor excision (communicating hydrocephalus). In 2 cases with benign tumours reasons of failures were not clear (patent stomies on PC MR-cine) and in 1 case late stomy occlusion on PC-MR flow study was diagnosed. Five out of 6 patients underwent shunt placements and in 1 case with late ventriculostomy occlusion another endoscopic procedure (after 26 months) was successfully performed.

CONCLUSIONS

The endoscopic third ventriculostomy was an efficient method to control non-communicating hydrocephalus in children with posterior part of the third ventricle brain tumours. The PC MR flow study was a useful diagnostic tool in the stomy patency evaluation and in further treatment planning in cases of failures. It seems that recurrence of active hydrocephalus can be successfully treated with repeated ETV when the stomy occlusion is detected on MR flow studies. Other cases of failures ought to be treated by shunt implantations.