Endoscopic surgery of the patients with idiopathic hydrocephalus due to extraventricular cisternal obstruction

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The possibility of developing hydrocephalus due to extraventricular cisternal obstruction was discovered in the 20th century. The development of neuroimaging and endoscopic techniques has made it possible to plan and perform minimally invasive surgeries in a narrow anatomical corridor with a good results. PURPOSE OF THE STUDY: to determine the effectiveness of endoscopic surgery for hydrocephalus due to idiopathic extraventricular cisternal obstruction of the CSF pathways. MATERIALS AND METHODS. Sixty-five patients with hydrocephalus due to extraventricular obstruction was evaluated and operated at the Center of Neurosurgery from 2007 to 2020. Preoperative Kiefer scale rate was 6.8 + 3.3 (0–15) points, and Rankin scale rate — 2.2 + 1 (0–5) points. Endoscopic third ventriculocisternostomy was performed in 42 (64.6 %) patients. Shunt-surgery was performed in 17 (26.1 %) patients. Six (9.2 %) patients didn’t operate. RESULTS. After endoscopic surgery, the condition of patients significantly improved (p < 0.001) after 2 and 12 months. Complete or partial regression of symptoms was noted in 85 % of patients 1 year after surgery. After shunt-surgery, the trend is comparable. The only position of the premamillary membrane and “flow void” have correlated with the condition of patients. Other characteristics of the CSF-pathways of the brain didn’t actually change. In all cases of the endoscopic surgery, an additional membrane conglomerate was found under the premamillary membrane that was the same to preoperative tomograms. CONCLUSION. The high efficiency of endoscopic third ventriculocisternostomy allows to recommend using that as the primary one in patients with extraventricular obstruction of the CSF pathways. but not for cases of anatomy abnormalities of the third ventricular fundus area (short premamillary membrane in combination with a high standing bifurcation of the basilar artery) and cisterns of the posterior cranial fossa base (narrow cisterns, impossibility to move endoscope under the premamillary membrane).

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