ENDOSCOPIC THIRD VENTRICULOSTOMY IN TREATMENT OF HYDROCEPHALUS BY NEUROCYSTICERCOSIS: CASE REPORT
the countryside. It’s extraparenchymal form is a important cause of hydrocephalus
in adults, being of great clinical and epidemiological importance to the Grand
Dourados region. Case report A.I.G., 47-year-old female, from Dourados-MS.
Presented to the hospital unity complaining of cephalea and progressive visual loss.
Encephalic MRI identified nodular cystic formation at the IV ventricle, and
consequente supratentorial ventricular cavities dilatation. It confirmed the diagnosis
of obstructive hydrocephalus, secondary to cyst on IV ventricle. Surgical treatment
was proposed, and patient underwent endoscopic third ventriculostomy (ETV),
which lasted two hours. There were no accidents or complications. Patient was
discharged the day after. Discussion: ETV was the chosen procedure for the cyst
didn’t compress any important structure and didn’t show any evidence of size
increase, what, allied to craniotomy complexity, discarded the need to remove it.
Obstructive hydrocephalus’ most used treatments nowadays are shunts with valves
(especially VPS) and internal endoscopic shunts, (such as ETV). In VPS the need of
reoperation is common, due to problems of obstruction and infection. There are,
also, reports of patients allergic to silicone, who, therefore, don’t tolerate the
prosthesis. On the other hand, ETV improves the liquor’s flow through the third
ventricle’s floor fenestration, dismissing the need of prosthesis and showing less
reoperation rates. It is usually recommended to obstructive hydrocephalus (this
patient’s case) and also other pathologies, like aqueductal stenosis. In general, it’s
not an effective procedure for communicating hydrocephalus, meningitis or any
other case of liquor’s excessive production or its poor drainage. It also has its
potential to complications, such as hypothalamic and basilar artery injury, and third
and sixth cranial nerves’ paralysis. Long-term radiographic accompaniment is
essential to ascertain success.
To counselor Prof. Dr. Irineu Renzi Junior, from Universidade de São Paulo.
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