Treatment outcome of endoscopic third ventriculostomy in obstructive hydrocephalus patients at Tikur Anbessa Specialized Hospital, and Myung sung Christian Medical Center from January 1 2016 to June 30 2020 G.C

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Addis Abeba University


Objective: To analyse the overall outcome of ETV in obstructive hydrocephalus in relation to neurosurgery experiences on patient selection, intraoperative incidents, post-operative complications and follow up results. Predictors for post op complications, factors responsible for successful outcome and validation of ETVSS for adult patients were also taken into account. Methodology: Institution based cross sectional retrospective study was conducted among 68 patients for whom ETV has been done at Tikur Anbessa Specialised Hospital and MCM hospital from January 1 2016 to June 30 2020 G.C. Data obtained for analysis included patient demographics, clinical manifestations, underlying etiology, ETVSS, peri operative incidents and follow up results. Collected data from patients’ medical chart using data collection checklist was checked for completeness, coded and entered to SPSS version 25 for analysis. Descriptive statistics and Binary Logistic Regression were used for data analysis. Results: Mean age at the time of procedure was 29.4yrs (Range from 2years to 68 years, SD=17.8). of which, patients aged ≥ 15 years constituted 76.5% of study population. Brain tumours (67.9%), Aqueductal Stenosis (14.7%), and PIH (11.8%) were causes of hydrocephalus in most study participants. Intraoperative uncontrolled haemorrhage (13.2%) and distorted 3rd ventricular floor anatomy (7.3%) has led to insertion of EVDs in 19.1% that subsequently led to ventriculitis in 11.8% (61.5% of all EVDs). Other encountered post op complications are IVH (14.7%), ICH (4.4%) and CSF leak (4.4%) with overall morbidity of 22%. With a mean follow up of 7.45 months, the total number of patients with shunt free survival up to their last follow up month becomes 59 with overall successful outcome of 86.7%. The mean duration of ETV failures were found to be on 20th post-operative day (range 5 to 52 days). Younger age (31.2%, PIH (50%), uncontrolled bleeding (44.4%), distorted ventricular anatomy (60%), EVD insertion (53.8%), ventriculitis (75%) and post op IVH (40%) were associated with failed outcome. Among the 68.7% of patients with a high probability of ETVSS 93.6% had a successful outcome. Conclusions: Endoscopic third ventriculostomy is a safer and more effective treatment option for obstructive hydrocephalus. Factors indicating potential poor ETV outcome are distorted ventricular anatomy, post op IVH and ventriculitis



Ventriculostomy, hydrocephalus, outcome