Endoscopic ventriculocisternostomy in the treatment of obstructive hydrocephalus in children

Description

Obstructive hydrocephalus is a frequent pathology in pediatrics, its etiologies are multiple, most often malformative and hemorrhagic in the neonatal period, post meningeal in infants and tumor in older children. At this age, macrocrania is the main clinical manifestation. To date, the treatment of hydrocephalus is surgical and uses two main methods: ventriculoperitoneal shunt and endoscopic ventriculocisternostomy. The latter, known since the beginning of the 20th century, has gained real importance and has proven its safety and efficacy in recent years, thanks to technical progress and improvements in endoscopic equipment. In the pediatric setting, endoscopic ventriculocisternostomy represents today the reference treatment for obstructive hydrocephalus in children with: 88% success rate. The technique is fast, suitable for all ages with a low risk of infection. Since its advent, it has been a reliable alternative to ventriculoperitoneal shunting and has considerably reduced the number of re-interventions. In addition, certain factors seem to be often associated with the dysfunction of endoscopic ventriculocisternostomy in children, including: age, bulging fontanelle, ectasia of the scalp veins, arachnoid adhesions, closure of the aqueduct of Sylvius and pulsation of the floor of the 3rd V. These difficulties lead us to reconsider our expectations in the hope that new advances in visualization methods will guide future progress in minimally invasive neurosurgery.