Results of endoscopic septal fenestration in the treatment of isolated ventricular hydrocephalus

A surgical series detailing the results and complications of neuroendoscopy for the treatment of isolated lateral ventricular hydrocephalus (ILVH) has yet to be presented. This retrospective case review of 32 patients examines our experience at the Primary Children's Medical Center with endoscopic fenestration of the septum pellucidum (septostomy) for ILVH. The patients who underwent endoscopic septostomy between the years of 1993 and 2001 were identified from our database. Forty-three septostomies were performed, with a mean follow-up of 30.9 months. Fifty-three percent of initial septostomies remained patent. Nine patients had a least one more septostomy performed after failure of their initial septostomy. All but one was successful. Including repeat septostomies, 81% of the patients had relief of their ILVH on the last follow-up. No septostomy failures occurred later than 6 months postoperatively. A history of multiple previous shunt procedures was highly predictive of initial septostomy failure, increasing this risk 4.5 times. Complications involved significant intraventricular hemorrhage, wound breakdown, shunt infection and sterile meningitis in four cases. We conclude that endoscopic septostomy is a reasonable treatment option for ILVH, avoiding additional shunts. Outcome is negatively affected by multiple prior shunt procedures. Favorable results can be achieved with repeat septostomies in patients who have failed prior septostomy. Lasting results are expected for septostomies that remain patent after 6 months.