Endoscopic third ventriculostomy in idiopathic normal pressure hydrocephalus

Objective: To determine the efficacy of endoscopic fenestration of the third ventricle in the treatment of idiopathic normal pressure hydrocephalus. Methods: 16 patients with idiopathic normal pressure hydrocephalus were treated by endoscopic third ventriculostomy. This study lasted three years. All patients were over 50 years old complaining of 2 or more of the famous triad of gait disturbance, urinary incontinence and dementia. All patients had ventricular dilatation with negative history of infection, brain injury or hemorrhage. Results: 8 patients showed marked improvement in their clinical conditions, 3 patients showed mild improvement, while 5 patients had no improvement without any deterioration in their preoperative state. Thus the overall improvement after ventriculostomy occurred in 11 patients (68%). Conclusion: Endoscopic third ventriculostomy is as effective as shunt in treating idiopathic normal pressure hydrocephalus. Patients must be treated as early as possible before permanent damages occur. Further studies are needed to clarify more about the pathophysiology, CSF dynamics and new management.