trabajo presentado en el congreso mundial de neurocirugia en Boston 2009. mas de 200 casos operados por neurocirugia endoscópica por hidrocefalia.

1. Arturo Ayala Arcipreste, Rafael Mendizabal Guerra,
Rubén Acosta Garcés, Gervith Reyes, Carlos Delgado.
Neurosurgery Department.
Hospital Juárez de México.
México City.
Neuroendoscopic management
of Hidrocephalus on Hospital
Juárez de México.

2. Background
1910 L´Espinasse inserted a
cystoscope to view lateral
ventricles.
1922 Dandy make a
electrofulguration of coroids
plexus like management of
hydrocephalus.
1923 Mixter make the firts
third –ventriculostomy.
1935 Fay and Grant take
pictures of the lateral
ventricles
1962 Bosma adapted a 8 mm
camera to film the endoscopic
procedures.
1963 Guiot used a quartz lens
and light source to improve the
image quality.
1980 to actuallity….Percnezky,
Fries, Gaab, Cohen,
Schroeder..
Endoscopic third
ventriculostomy has gained
popularity and has become the
first choice for certain adult
and pediatric hydrocephalus
conditions.

3. Objetives
Demostrate the experience of
the neuroendoscopic
management to resolve
hydrocephalus with variate
etiology in our health
institution.

4. Material and Methods
Retrospective and descriptive study
We include all the patients operated with neuroendoscopic
technique with diagnosis of hydrocephalus confirmed by image
studies between 2004 and 2008 at the Hospital Juárez de
México with follow up of 6 months as minimun.
Total of 234 patients were treated with neuroendoscopic
technique, we select 185 patients :91 males (3-83y old m:43)
94 females (4-72 y old m:37) to whom were performed a 195
neuroendoscopic procedures.
All the patients had symptoms of hydrocephalus and be
corroborated with image studies (CT or IRM).
We used rigid neuroendoscope for all procedures.

5. Methods

6. Etiology of
hydrocephalus
Clinical improve
(n=162) 87.5%
Without improve
(n=23) 12.4%
Aqueductal stenosis
(n= 28)
27 (16.6%) 1 (4.3%)
Non communicating
hydrocephalus by tumors
(n= 87)
81 (50%) 6 (26%)
Meningitis and
cysticercosis
(n= 30)
23 (14.1%) 7 (30.4%)
Hydrocephalus with
uncertain origen
(n=19)
18 (11.1%) 1 (4.3%)
Intraventricular and
subarachnoid
hemorrhage (n=21)
13 (18.5%) 8 (34.7%)

7. Results
Clinical improve
(162)
Without
improve
(23)
Age 3 to 83 years
old
(m:43).
4 to 72 years
old
(m: 37).
Sex M= 84 F= 78 M= 7 F= 16
On firts 24 hours the 82% of the patients showed improve of
symptoms.
At 5 weeks of follow up the hydrocephalus was resolve on
80% on the CT image.

8. Results.
Complications
(15) 8.1%
Clinical
improve
(162)
Without
improve
(23)
Subdural hematoma 1 0
Intraventricular
Hemorrhage
1 3
Pneumoencephalus 2 2
Brain tissue Injury
due to anomalus
route
1 0
Meningitis 1 4
All 23 patients without improve requiered
ventriculo peritoneal shunt.

9. Discussion
In this serie of 185 patients
with hydrocephalus treated
with neuroendoscopic
techniques, the 87.5%
improve the clinical status,
and 12.4% did not show
clinical improve and
requiered a ventriculo
peritoneal shunt.
We consider this rate
succesfull.
Other series reporting a
success rate from 50 to
94%.
Our rate of surgical
complications was of 8.1%.
Other series reporting a 6 to
14% on complications rate.
No mortality are relationated
with the surgical procedure in
our serie.
Inflamatory pathology like
infections and events that
affect the absortion
mechanisms have more
complications than others
when the obstruction of flow
is affected.

10. Discussion
The indication to
neuroendoscopy are
changing with the time,
firstly was only for non
communicating
hydrocephalus but the
presence of intraventricular
cysts clots or tumors are
indicated to the procedure,
including the septum
fenestration and the
endoscopic supervision of
shunt insertion are
reported.
Series reported by
Percknezky, Fries, Gaab,
Dusick, Amin, Beems
confirmed that the
endoscopic managment of
hydrocephalus ,mainly the
third ventriculsotomy is an
effective procedure to be
shunt indepence.

11. Conclusion
The surgical technique, and
the outcome depends of
the etiology of the
hydrocephalus.
The inflamatory pathology
like infections including
cysticercosis and
intraventricular
hemorrhage demostrated
less clinical improve and
higher rate of
complications.
The neuroendoscopic
procedures to resolve
hydrocephalus is safe and
effective.
The third-ventriculostomy is
the most common
endoscopic technique on
the world wide for
hydrocephalus.
Our results are similar to
world wide with endoscopic
experience.