• Sascha Marx, Joerg Baldauf, Marc Matthes, Michael R Gaab, and Schroeder Henry W S HWS Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany..
• Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany.
• Neurosurgery. 2019 Jul 1; 85 (1): 91-95.

BackgroundDuring the 1990s, endoscopic aqueductoplasty (AP) was considered to be a valuable alternative to endoscopic third ventriculostomy (ETV) in treating hydrocephalus related to idiopathic aqueductal stenosis (iAS), with promising short-term outcomes.ObjectiveTo evaluate the long-term outcome of AP in the treatment of iAS.MethodsLong-term follow-up clinical examinations and magnetic resonance (MR) imaging were performed for patients treated by an AP for iAS in our department.ResultsTwenty patients (14 female, 6 male, mean age 41.7 yr, range 0.5-67 yr) were treated between 1996 and 2002. Two patients were lost to long-term follow-up. One patient died 6 mo after AP, but death was not related to the procedure. The mean follow-up for the remaining 17 patients was 120 mo. Clinically relevant aqueductal reclosure was observed in 11/17 patients after a mean follow-up of 53.4 mo. These 11 patients underwent ETV, which has been successful during further follow-up. Four of the six remaining patients presented with no clinical symptoms, although aqueductal restenosis was observed on MR imaging. Thus, the overall failure rate of AP was 88.2%. The failures were homogeneously distributed over the entire follow-up period.ConclusionAP has a high risk of failure during long-term follow-up and is not recommended as the first choice of treatment in hydrocephalus caused by iAS. ETV should be done instead. AP may be reserved for a limited number of patients in whom ETV is not feasible but should be combined with stenting to avoid reclosure of the aqueduct.Copyright © 2018 by the Congress of Neurological Surgeons.

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