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Vol. 15. Issue 3.
Pages 248-256 (January 2004)
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Vol. 15. Issue 3.
Pages 248-256 (January 2004)
Ventriculostomia endoscópica: influencia de factores predisponentes al fallo y evolución del tamaño ventricular
Endoscopic third ventriculostomy: risk factors for failure and evolution of ventricular size
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D. Santamaría
, I. Onzain, J.A. Blázquez, J.A. Gómez-Moreta, F. Morales
Servicio de Neurocirugía. Hospital Universitario. Salamanca
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Article information
Resumen
Introducción

La ventriculostomia endoscópica es en nuestro centro el tratamiento de primera elección para la hidrocefalia no comunicante. Hay una serie de factores favorecedores de un fracaso de la intervención. El objetivo de este trabajo ha sido analizar su influencia en nuestra serie.

Material y métodos

Cincuenta y seis pacientes (edad media 48.5 años) han sido tratados mediante ventriculostomia endoscópica durante el periodo 1997–2002. Se han diferenciado formas agudas (68%) y formas crónicas de hidrocefalia. La etiología se clasificó en lesiones ocupantes de espacio (59%), estenosis primaria del acueducto (34%) y malformación de Chiari (7%). Consideramos los siguientes factores predisponentes al fracaso: edad inferior a 12 meses, antecedentes de mielomeningocele, radioterapia, craneotomía, infección de líquido cefalorraquídeo (LCR), hemorragia intracraneal y tratamiento previo de la hidrocefalia con un shunt. Se analizó la evolución de cuatro índices de tamaño ventricular comparando la última imagen postoperatoria con la preoperatoria.

Resultados

Después de un periodo de seguimiento medio de 26 meses, la intervención ha sido efectiva en el 71.4% de los pacientes. La hidrocefalia secundaria a metástasis localizadas en áreas que dificultan la circulación de LCR se asocia con fracaso de la ventriculostomia (p=0.006). Ninguno de los factores predisponentes al fallo ha mostrado relación con el resultado de la intervención. La evolución del tamaño ventricular depende de la eficacia. El índice de Evans, índice del tercer ventrículo, índice de celia media y el índice ventricular global disminuyen si la ventriculostomia es eficaz y aumentan en caso de fallo (p<0.05).

Conclusión

En la hidrocefalia secundaria a metástasis cerebrales la eficacia de una ventriculostomia endoscópica es menor por una probable implicación de otros mecanismos fisiopatológicos, además de una obstrucción en la circulación de LCR. La evolución del tamaño ventricular se relaciona con el resultado de la ventriculostomia.

Palabras clave:
Hidrocefalia
Ventriculostomia endoscópica
Ventrículo
Resultado
Summary
Introduction

Endoscopic third ventriculostomy is the treatment of choice for non communicating hydrocephalus at our institution. Several factors have been associated with failure of endoscopic third ventriculostomy. The goals of the study have been to evaluate the outcome, the influence of factors theoretically prone to failure of ventriculostomy and the evolution of ventricular size.

Material and methods

Fifty-six patients (mean age 48.5 yrs) treated with an endoscopic third ventriculostomy during the period 1997–2002 were analysed retrospectively. Hydrocephalus was classified as acute (68%) and chronic forms. Etiology was classified in space-occupying lesions (59%), primary aqueductal stenosis (34%) and Chiari malformation (7%). The presence of the following factors theoretically prone to failure was considered: age below one year, history of mielomeningocele, cerebrospinal fluid (CSF) infection, intracranial haemorrhage, radiotherapy, craniotomy and previous treatment of hydrocephalus with a shunt. Ventricular size was measured linearly with four ventricular index pre- and postoperatively.

Results

The global success rate was 71.4% (mean follow-up 26 months). Endoscopic third ventriculostomy for hydrocephalus secondary to cerebral metastases obstructing CSF pathways was associated with a higher risk of failure (p=0.006). None of the risk factors considered was associated with a higher risk of failure. The evolution of the ventricular size measured with linear methods is associated with outeome. Evans ratio, third ventricle index, celia media index and ventricular score decreased in patients whose outeome is satisfactory and increased in those cases deemed clinical failures (p<0.05).

Conclusión

The risk of failure increases in patients with cerebral metastases cióse to CSF pathways, likely due to the concurrence of mechanisms other than obstruction. Changes in ventricular size are associated with outeome.

Key words:
Hydrocephalus
Endoscopic third ventriculostomy
Ventricle
Outeome

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