Variations in ventricular endoscopic findings in infants wiith Hydrocephalus
Background: Endoscopic Third Ventriculostomy has become well accepted as a standard treatment option for selected patients with symptomatic obstructive hydrocephalus. It has become established as an alternative to initial ventriculoperitoneal (VP Shunting) and ventriculoatrial shunt implantation and to revision of a failed shunt. The procedure has a relatively high failure rate in infants. Factors that seem to contribute to ETV failure include the patients age and the aetiology of hydrocephalus. Variant anatomic findings have been sporadically reported and seem to contribute significantly to ETV failure. This study documented the variant anatomic findings of Third Ventricle encountered in neuroendoscopy. Objective: The study aimed to document the variant anatomy of the third ventricle as seen during neuroendoscopy in infants with hydrocephalus. Materials and Methods: The study was prospective cross-sectional descriptive studies carried out at the Kenyatta National Hospital (KNH) and The Aga Khan University Hospital (AKUH). Thirty three/patients were included in the study. The patients, who met inclusion criteria, were recruited over a period of 6 months from December 2010 to May 2011. The video recordings of 33 patients who underwent ETV were reviewed. Using a structured questionnaire data was collected and SPSS 17.0 was used to analyze the data. Analysis was done by associating occurrence of variant endoscopic findings to: age. sex, aetiology of hydrocephalus and duration of operating time. Charts and tables were used to present the results Results: In 27 of the 33 patients, variant endoscopic findings were encountered accounting for an incidence rate of 81.8%. Variant findings were present in the wall of the third ventricle in 27 (81.85%) of infants while variant ventricle floor findings were present in 17 (51.5%) of infants. Sixteen (48.5%) infants had variations in ventricular endoscopic findings affecting both the. ventricle wall and floor. ETV was completed in all 6 patients without variant anatomy. Where variant findings occurred, the length of the procedure was prolonged with increasing variability. 2 out of 27 procedures were not completed due to obscured visibility. Conclusion: Variant findings in the third ventricle are a frequent finding during ETV in infants and seem to have the potential to increase the difficulty of the operation as is indicated by the increased operating time that occurred with greater variability. Successful perforation and shorter operation correlated with absence of anatomic variants.