Effectiveness And Prognostic Factors Of Endoscopic Fenestration In The Treatment Of Hydrocephalus And Arachnoid Cysts

Background and ObjectiveTo analyze the effectiveness and investigate prognostic factors of endoscopic fenestration in the treatment of childrood hydrocephalus and intracranial arachnoid cysrtsMethodsClinical data of 118 patients under 18 years of age who underwent endoscopic fenestration from May 2010 to June 2015 were reviewed.Our material consisted of 101 patients with hydrocephalus and 31 patients with arachnoid cysts(14 arachnoid cysts with hydrocephalus).For patients with hydrocephalus we performed endoscopic third ventriculostomy(ETV),and for patients with arachnoid cysts we performed endoscopic cystoventriculostomy and/or cystocisternostomy.Outcome was assessed based on pre-and post-operative clinical status and radiologic examination.Results95 patients had achieved satisfactory outcomes and the overall success rate was 80.5%.Clinical symptomatic improvement was achieved in 78.2%(79/101)of patients with hydrocephalus and 90.3%(28/31)of patients with arachnoid cysts.The success rates of hydrocephalus with different etiology were as follows:96.2% success(25/26)for tumors and 85.7%(12/14)for intracranial cysts,71.4%(20/28)for aqueductal stenosis,55.6%(5/9)for CNS infection,62.5%(5/8)for hemorrhage,66.7%(6/9)for Chiari malformations,100%(4/4)for other reason of obstructive hydrocephalus and 66.7(2/3)for communicating hydrocephalus.The success rate was 68.5%(37/54)for children younger than 2 years of age and 64.0%(16/25)in patients less than 1year.By contrast,for children elder than 2 years,this rate was 89.1%(57/64).ConclusionsBased on our material we conclude that endoscopic fenestration is a effective and safe procedure in the treatment of childrood hydrocephalus and intracranial cysrts.But the outcome is related to the age of the patient,etiology and other factors,the failure is related to stoma obstruction and decreased CSF resorption capacity.