Influence of the State of the Subarachnoid Space of the Cranial Base in Hydrocephalus Resolution after Endoscopy

Abstract

Objective To compare the resolution rate of hydrocephalus after endoscopy (predominantly endoscopic third ventriculostomy [ETV]) using flexible endoscopes during a 5-year period in patients with a permeable and a nonpermeable subarachnoid space (SAS).

Material and Methods We conducted a retrospective cohort study of the videos and records of 150 hydrocephalic patients chosen randomly who underwent ETV (and other endoscopic procedures) with a flexible endoscope. The patients were classified into two groups based on the neuroendoscopic findings. The first group included patients with a permeable SAS, and the second group included patients with a nonpermeable SAS. A normal SAS or one with slight arachnoiditis was considered permeable. Adhesive arachnoiditis and immature or mechanically obliterated SASs were considered nonpermeable.

Results We found a success rate of 70% in patients with a permeable SAS versus 33% in patients with a nonpermeable SAS. The baseline characteristics of both groups were homogeneous. We obtained a statistically significant difference (p < 0.0001) with hazard ratio (HR) 3.42 (95% confidence interval [CI], 1.88–6.22). Another important factor involved was age that showed a statistically significant difference (p < 0.0018) with HR 3.28 (95% CI, 1.55–6.93).

Conclusion The permeability of the SAS is an important prognostic factor in the resolution rate of hydrocephalus after ETV (and other endoscopic procedures) using flexible neuroendoscopes. Therefore we recommend that the characteristics of the SAS be examined following every endoscopic procedure for hydrocephalus to identify patients at risk of recurrence.

Keywords

flexible neuroendoscopy - hydrocephalus - third ventriculoscopy - subarachnoid space

• References

• 1 Woodworth G, McGirt MJ, Thomas G, Williams MA, Rigamonti D. Prior CSF shunting increases the risk of endoscopic third ventriculostomy failure in the treatment of obstructive hydrocephalus in adults. Neurol Res 2007; 29 (1) 27-31
• 2 Fritsch MJ, Kienke S, Ankermann T, Padoin M, Mehdorn HM. Endoscopic third ventriculostomy in infants. J Neurosurg 2005; 103 (1, Suppl): 50-53
• 3 Gangemi M, Maiuri F, Colella G, Buonamassa S. Endoscopic surgery for pineal region tumors. Minim Invasive Neurosurg 2001; 44 (2) 70-73
• 4 Moorthy RK, Rajshekhar V. Endoscopic third ventriculostomy for hydrocephalus: a review of indications, outcomes, and complications. Neurol India 2011; 59 (6) 848-854
• 5 Obaid S, Weil AG, Rahme R, Bojanowski MW. Endoscopic third ventriculostomy for obstructive hydrocephalus due to intraventricular hemorrhage. J Neurol Surg A 2015; 76: 99-111
• 6 O'Brien DF, Hayhurst C, Pizer B, Mallucci CL. Outcomes in patients undergoing single-trajectory endoscopic third ventriculostomy and endoscopic biopsy for midline tumors presenting with obstructive hydrocephalus. J Neurosurg 2006; 105 (3, Suppl): 219-226
• 7 Rangel-Castilla L, Hwang SW, Jea A, Torres-Corzo J. Efficacy and safety of endoscopic transventricular lamina terminalis fenestration for hydrocephalus. Neurosurgery 2012; 71 (2) 464-473 ; discussion 473
• 8 Kashcheev AA, Arestov SO, Gushcha AO. Flexible endoscopy in surgical treatment of spinal adhesive arachnoiditis and arachnoid cysts [in Russian]. Vopr Neirokhir 2013; 77 (5) 44-54 ; discussion 54–55
• 9 Torres-Corzo JG, Tapia-Pérez JH, Vecchia RR, Chalita-Williams JC, Sánchez-Aguilar M, Sánchez-Rodríguez JJ. Endoscopic management of hydrocephalus due to neurocysticercosis. Clin Neurol Neurosurg 2010; 112 (1) 11-16
• 10 Brown PD, Davies SL, Speake T, Millar ID. Molecular mechanisms of cerebrospinal fluid production. Neuroscience 2004; 129 (4) 957-970
• 11 Orešković D, Klarica M. Development of hydrocephalus and classical hypothesis of cerebrospinal fluid hydrodynamics: facts and illusions. Prog Neurobiol 2011; 94 (3) 238-258
• 12 Cushing H. Studies on the cerebrospinal fluid: I. Introduction. J Med Res 1914; 31 (1) 1-19
• 13 Brodbelt A, Stoodley M. CSF pathways: a review. Br J Neurosurg 2007; 21 (5) 510-520
• 14 Tripathi R. Proceedings: Light and electron microscopical studies of the exit pathway of cerebrospinal fluid. J Anat 1974; 118 (Pt 2): 379-380
• 15 Mallucci C, Sgouros S. Cerebrospinal Fluid Disorders. New York, NY: Informa Healthcare; 2010: 1-15
• 16 Bradbury MWB. Lymphatics and central nervous system. Trends Neurosci 1981; 4: 100-101
• 17 Ogiwara H, Dipatri Jr AJ, Alden TD, Bowman RM, Tomita T. Endoscopic third ventriculostomy for obstructive hydrocephalus in children younger than 6 months of age. Childs Nerv Syst 2010; 26 (3) 343-347
• 18 Naftel RP, Reed GT, Kulkarni AV, Wellons JC. Evaluating the Children's Hospital of Alabama endoscopic third ventriculostomy experience using the Endoscopic Third Ventriculostomy Success Score: an external validation study. J Neurosurg Pediatr 2011; 8 (5) 494-501
• 19 Mohanty A, Biswas A, Satish S, Vollmer DG. Efficacy of endoscopic third ventriculostomy in fourth ventricular outlet obstruction. Neurosurgery 2008; 63 (5) 905-913 ; discussion 913–914
• 20 Proaño JV, Torres-Corzo J, Rodríguez-Della Vecchia R, Guizar-Sahagun G, Rangel-Castilla L. Intraventricular and subarachnoid basal cisterns neurocysticercosis: a comparative study between traditional treatment versus neuroendoscopic surgery. Childs Nerv Syst 2009; 25 (11) 1467-1475
• 21 Tapia-Pérez JH, Torres-Corzo JG, Chalita-Williams JC, Rodríguez-Della Vecchia R, Sánchez-Rodríguez JJ, Sánchez-Aguilar M. Endoscopic scoring system for extraparenchymal neurocysticercosis. World Neurosurg 2013; 79 (2) 340-346
• 22 Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958; 53: 457-481
• 23 Newcombe RG. Two-sided confidence intervals for the single proportion: comparison of seven methods. Stat Med 1998; 17 (8) 857-872
• 24 Wilson EB. Probable inference, the law of succession, and statistical inference. J Am Stat Assoc 1927; 22: 209-212
• 25 Motulsky HJ. (2007) Prism 5 Statistics Guide, GraphPad Software Inc., San Diego, CA. Available at: www.graphpad.com
• 26 Durnford AJ, Kirkham FJ, Mathad N, Sparrow OC. Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus: validation of a success score that predicts long-term outcome. J Neurosurg Pediatr 2011; 8 (5) 489-493
• 27 Costa Val JA, Scaldaferri PM, Furtado LM, de Souza Baptista G. Third ventriculostomy in infants younger than 1 year old. Childs Nerv Syst 2012; 28 (8) 1233-1235
• 28 Sandberg DI. Endoscopic management of hydrocephalus in pediatric patients: a review of indications, techniques, and outcomes. J Child Neurol 2008; 23 (5) 550-560