EXPERIENCE WITH ENDOSCOPIC THIRD VENTRICULOSTOMY IN THE MANAGEMENT OF HYDROCEPHALUS SECONDARY TO POSTERIOR FOSSA TUMOR

Objective: To analyze the outcome of endoscopic 3rd ventriculotomy in the management of hydrocephalus secondary to posterior fossa tumor. Methodology: Sixty five cases of hydrocephalus secondary to posterior fossa tumor underwent endoscopic 3rd ventriculostomy in the Department of Neurosurgery; Lady Reading Hospital, Peshawar Pakistan from January, 2011 to June, 2012 (18 months). This was an observational study and the sampling was by simple random method. Results: The study included 65 patients (37 males, 28 females); M/F ratio was 1.32; Age range was 1-45 years. Fifty one percent (33 cases) of posterior fossa tumors occurred in children less than five years, 23% (15 cases) in the 6-10 year age group, 16% (11 cases) occurred in 11-14 years and 10% (06 cases) in age group 14 yrs. Endoscopic third ventriculostomy was performed in 54 (83.07%) patients with successful outcome. Ventriculoperitoneal shunt was required in 5 (7.69%) patients for the suspicion of inadequate ventriculostomy. Ventricular drainage device (EVD) was inserted in 2 (3.07%) cases for hemorrhagic CSF. In 4 (6.15%) patients no drainage procedure was done (4th ventricle floor not involved / Aqueduct opening visible). Conclusions: Preoperative endoscopic third ventriculostomy (ETV) control the intracranial pressure (ICP), avoid the necessity of an emergency procedure, allow appropriate scheduling of the operation for tumor removal, and eliminate the risks related to the presence of an external drainage. The most common age group involved was under 5 years. The success rate of ETV was 83% and Medulloblastoma was the most common Histopathological findings.