World Neurosurg
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Massive intracerebral and intraventricular hemorrhages require aggressive and rapid management to decrease intracranial hypertension. The amount of intraventricular blood is a strong prognostic predictor, and its fast removal is a priority. Neuroendoscopy may offer some advantages over more traditional surgical approaches. ⋯ Early neuroendoscopic surgery is a feasible approach, allowing, in most instances, rapid clinical and radiological improvement.
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Endoscopic third ventriculostomy (ETV) is increasingly prevalent among pediatric neurosurgeons as the initial treatment for hydrocephalus. The combination of ETV and choroid plexus cauterization (ETV/CPC) has improved the success rate among infants with hydrocephalus for whom ETV alone is much less successful. In parts of the developing world where there are economic and human resource constraints, this mode of treatment may be more appropriate than the routine use of shunts, which are prone to failures that require urgent surgical treatment. Here we review indications for the use of ETV or ETV/CPC as the primary treatment for hydrocephalus. ⋯ Primary treatment of hydrocephalus by ETV can avoid shunt-dependence and its complications for many patients. Optimal results depend upon proper patient selection and the use of combined ETV/CPC when treating infants.
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To term and describe neuroendoscopic techniques. ⋯ Endoscopic techniques are a valuable addition to the neurosurgeon's armamentarium. Endoscopes are especially beneficial in deep and narrow surgical approaches and when "looking around a corner" is required.
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Endoscopy for hydrocephalus caused by infectious diseases presents clear challenges to the surgeon. Hydrocephalus caused by tuberculous meningitis is a good model to explore many of the issues that should be considered in the management of these patients. Tuberculous hydrocephalus may be communicating or noncommunicating management options include medical treatment (for communicating hydrocephalus), ventriculoperitoneal shunting, and endoscopic third ventriculostomy. ⋯ However, this also must be weighed against the surgical and long-term complications associated with the procedures used. There are specific endoscopic challenges that occur as the result of abnormal anatomy and the fact that hydrocephalus presents during the acute phase of the disease, rather than being postinfectious. In this article we examine the arguments for various therapeutic approaches and discuss the gathering experience in the literature about endoscopy in tuberculous meningitis in the context of overall management options.
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The management of complex hydrocephalus is challenging. There is no consensus of the best treatment for isolated fourth ventricles, arachnoid cysts, and multiloculated hydrocephalus, although the avoidance of multiple shunts is desirable. We reviewed our experience with the use of endoscopic techniques to simplify complex multicompartmental hydrocephalus to determine its efficacy and safety. ⋯ Endoscopic simplification of complex hydrocephalus enables dependence on only a single shunt in the majority of patients, and a significant proportion achieve shunt independence. Endoscopic management should be considered before the placement of a second shunt, and some cases require staged endoscopic procedures to adequately communicate multicompartmental hydrocephalus.