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Gangemi, Michelangelo M.D.; Maiuri, Francesco M.D.; Naddeo, Michele M.D.; Godano, Umberto M.D.; Mascari, Carmelo M.D.; Broggi, Giovanni M.D.; Ferroli, Paolo M.D.

doi: 10.1227/01.NEU.0000319522.34196.7B
Clinical Studies

OBJECTIVES: The aim of the report is to define the indications and results of endoscopic third ventriculostomy (ETV) in idiopathic normal pressure hydrocephalus and to discuss the physiopathological mechanism of this procedure.

METHODS: The cases of 110 patients with idiopathic normal pressure hydrocephalus who underwent ETV in four Italian neurosurgical centers were retrospectively reviewed. The postoperative outcome was correlated with patient age, length of clinical history, preoperative clinical score, symptoms of clinical onset, type of hydrocephalus, and intraoperative findings.

RESULTS: The follow-up period ranged from 2 to 12 years (average, 6.5 yr). The outcome evaluation was made 2 years after the procedure. Postoperative clinical improvement occurred in 76 (69.1%) of 110 patients. There was no correlation between success rate and patient age or type of ventricular enlargement (normal or enlarged fourth ventricle). Conversely, the rate of neurological improvement was higher in patients with shorter clinical history, better preoperative neurological score, and clinical onset with gait disturbances. Moreover, the intraoperative finding of the sudden reappearance of normal cerebral pulsations and significant downward and upward movements of the third ventricular floor after ETV was also correlated with a good outcome.

CONCLUSION: ETV results in a relatively high rate of clinical improvement and a low complication rate in patients with idiopathic normal pressure hydrocephalus. Therefore, it may be easily performed with the same approach used for intracranial pressure monitoring with low morbidity. However, our data must be confirmed by additional studies.

Department of Neurological Sciences, Section of Neurosurgery, Federico II University School of Medicine, Naples, Italy (Gangemi) (Maiuri)

Neurosurgical Clinic, San Giovanni Battista Hospital, Turin, Italy (Naddeo)

Division of Neurosurgery, Bellaria Hospital, Bologna, Italy (Godano) (Mascari)

Division of Neurosurgery, Carlo Besta Hospital, Milan, Italy (Broggi) (Ferroli)

Reprint requests: Michelangelo Gangemi, M.D., Divisione di Neurochirurgia Ed. 16, Policlinico Universitario Federico II V. Pansini 5, 80131 Naples, Italy. Email:

Received, July 17, 2007.

Accepted, April 17, 2008.

Copyright © by the Congress of Neurological Surgeons