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Child's Nervous System
Published in: Child's Nervous System 12/2010

01-12-2010 | Review Paper

Use of endoscopic third ventriculostomy in hydrocephalus of tubercular origin

Authors: Sanat Bhagwati, Nirav Mehta, Suneel Shah

Published in: Child's Nervous System | Issue 12/2010

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Abstract

Purpose

The purpose of this paper was to study the feasibility of endoscopic third ventriculostomy (ETV) as a treatment modality in patients with hydrocephalus of tubercular origin.

Materials and methods

Literature on ETV in hydrocephalus of tubercular origin has been reviewed, and we have gathered experiences of neurosurgeons from various institutions in our country practicing ETV.

Results

Hydrocephalus, a common complication of tubercular meningitis, may be of communicating type or of obstructive variety. The communicating type is treated by medical therapy in 70–92% cases, whereas the obstructive type requires surgical intervention. The outcome of surgery depends upon gradation of disease. Shunting however has been a nightmare for neurosurgeons treating such patients (Smyth et al., Pediatr Neurosurg 39: 258–263, 2003). The shunts tend to get blocked with debris. Having found ETV as a successful modality of treatment in obstructive hydrocephalus of other etiology, neurosurgeons have attempted it in hydrocephalus of tubercular origin. Though various authors have had a success rate of 65–68%, failure has been quite high in acute cases due to thickening of the floor of third ventricle and distorted anatomy. The success rate is higher in chronic and burnt out cases.

Conclusion

Tubercular meningitic hydrocephalus is difficult to treat endoscopically as compared with other forms of meningitic hydrocephalus and requires adequate expertise and experience, especially in acute cases. Therefore, one would be justified in avoiding the use of ETV in acute cases and wait till patient presents with a failed shunt. Use of ETV in subacute and chronic cases seems to be justified as the first line of treatment.
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Metadata
Title
Use of endoscopic third ventriculostomy in hydrocephalus of tubercular origin
Authors
Sanat Bhagwati
Nirav Mehta
Suneel Shah
Publication date
01-12-2010
Publisher
Springer-Verlag
Published in
Child's Nervous System / Issue 12/2010
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI
https://doi.org/10.1007/s00381-010-1183-1

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