Endoscopic Third Ventriculostomy in Patients With Vestibular Schwannoma and Hydrocephalus: A Clinical Trial

摘要

Objective: The purpose of this study was to elucidate the efficacy of endoscopic third ventriculostomy (ETV) and prognosis after treatment in patients with obstructive hydrocephalus due to vestibular schwannoma (VS). Patients and Methods: Between 2010 and 2012, 8 adults with VS underwent endoscopic procedures for the treatment of hydrocephalus at the authors' institution. Five patients were male individuals and 3 were female individuals. The patients had a mean age of 47.5 years and a follow-up period of 6 months. All cases had VS, with a mass effect on brainstem and associated obstructive hydrocephalus. ETV was performed using a rigid adult endoscope. Postoperatively, patients were followed up with physical examination and serial imaging studies (computed tomography scan and magnetic resonance imaging), and their cerebrospinal fluid flow through the stoma was evaluated. Nonparametric tests were applied for small number of patients, the Fisher exact test was applied for categorical variables, and the Mann-Whitney U test was applied for continuous variables. Results: The treatment outcome was successful in 5 patients (62.5%) and failed in 3 patients (1 patient died). A major complication in our cases was meningitis. There were 2 confirmed meningitis cases related to ETV in this group. During the follow-up period, the overall success rate was 62.5%. Conclusions: ETV is a safe procedure and an effective treatment option for hydrocephalus. Age and the analysis of underlying causes of hydrocephalus play important roles in the outcome prediction in patients with hydrocephalus who undergo ETV. Randomized clinical studies are needed to explore further the role of this treatment in patients having obstructive hydrocephalus associated with VS.