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DOI: 10.1055/s-0030-1263107
© Georg Thieme Verlag KG Stuttgart · New York
Water Jet Dissection Technique for Endoscopic Third Ventriculostomy Minimises the Risk of Bleeding and Neurological Complications in Obstructive Hydrocephalus with a Thick and Opaque Third Ventricle Floor
Publication History
Publication Date:
03 December 2010 (online)
Abstract
Background: Endoscopic third ventriculostomy (ETV) is a procedure of choice in the treatment of obstructive hydrocephalus. Neurovascular injury while perforating the ventricular floor can occur when using a conventional probe, especially in patients with a thick and opaque third ventricle floor. The water jet dissection technique can be useful in such cases to perform an initial perforation.
Patients/Material and Methods: The water jet dissection technique was used to perform ETV in 36 patients with obstructive hydrocephalus with a thick and opaque third ventricle floor over a 3-year period. A water jet was generated using a syringe connected to a 2-mm catheter.
Results: The water jet dissection technique successfully created a patent ETV stoma in 31 patients. 5 patients needed a re-operation due to a blocked stoma. There were no complications related to the procedure. An improvement in clinical function was seen in 28 (83.3%) patients at a median follow-up of 29 months.
Conclusion: The water jet dissection is a useful technique while performing ETV to prevent neurovascular injury. Our improvised technique of creating a water jet is safe, inexpensive, readily available and can be practiced at any centre performing ETV.
Key words
endoscopic third ventriculostomy - water jet dissection - obstructive hydrocephalus - tuberculous meningitis
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Correspondence
G. MukerjiMD
Department of Neurosciences
and Urology
Peipheral Neuropathy Unit
Hammersmith Hospital
Imperial College
Du Cane Road
London W12 0NN
UK
Phone: +44/7766/828064
Fax: +44/208/383 3363
Email: g.mukerji@imperial.ac.uk