Turkish Neurosurgery
Endoscopic Third Ventriculostomy plus Valveless Catheter in the Treatment of Low-Pressure Hydrocephalus.
Juan F. Villalonga1, Amparo Saenz1, José I. Pailler1, Andrea L. Castillo1, Mario Gomar Alba1, Solari Domenico2, Alvaro Campero1, Luigi M. Cavallo2, Guiseppe Cinalli3
1Facultad de Medicina, Universidad Nacional de Tucumán Argentina, Neurosurgery, Tucumán ,
2Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico , Neurosrugery, Naples,
3Department of Pediatric Neurosurgery, Santobono-Pausilipon Children´s Hospital, AORN, Neurosurgery, Naples,
DOI: 10.5137/1019-5149.JTN.47801-24.2

Aim:Despite the emergence of numerous techniques for diverting cerebrospinal fluid, the management of low-pressure hydrocephalus (LPH) remains challenging. The authors devised a simplified alternative surgical technique to treat LPH in resource-limited settings: performing an endoscopic third ventriculostomy and placing a valveless ventriculoperitoneal or ventriculoatrial shunt catheter. This study aimed to evaluate the outcomes achieved with this technique.Material and Methods:The new surgical technique was assessed in a prospective case series at a single center between December 2020 and December 2022. Patients were selected for the hybrid procedure based on the Pang–Altschuler diagnostic criteria for LPH. Those with normal or high-pressure hydrocephalus or less than six months of follow-up were excluded. All patients were evaluated clinically (Karnofsky performance status [KPS]) and radiologically (standardized set of images) in the preoperative and postoperative period, and their outcome was categorized as excellent, temporary improvement, or poor.Results:This case series comprised 16 patients. The mean postoperative improvement in KPS was 56 points. All patients showed improved KPS. All follow-up scans showed radiological improvement. System dysfunction and the need for a shunt with a valve were detected in 18.75% of cases (n = 3). The outcome was excellent in 81.25% of cases (n = 13) and temporary improvement in 18.75% (n = 3).Conclusion:The presented series demonstrated that the hybrid procedure effectively treats LPH and has minimal complications.

Corresponding author : Juan F. Villalonga