Endoscopic third ventriculostomy for the management of children with cerebrospinal fluid disorders, ventriculomegaly and associated Chiari I Malformation

Purpose: Our objective was to review the outcomes of children with CIM and associated cerebrospinal fluid (CSF) disorders and ventriculomegaly undergoing endoscopic third ventriculostomy (ETV) as a primary intervention. Materials: and methods: A retrospective, single-centre, observational cohort study was conducted, of consecutive children with CIM with associated CSF disorders and ventriculomegaly treated first by ETV between January 2014 and December 2020. Results: : Raised intracranial pressure symptoms were the most frequent with ten patients followed by posterior fossa and syrinx symptoms in three cases.One patient had a later closure of the stoma and required a shunt insertion. The success rate of the ETV in the cohort was 92% (11/12). There was no surgical mortality in our series. No other complications were reported.The median herniation of the tonsils was not statistically different in the pre vs post-operative MRI (1.14 vs. 0.94, p=0.1). However, the median Evan’s index (0.4 vs 0.36, p<0.01) and the median diameter of the third ventricle (1.35 vs. 0.76, p<0.01) were statistically different between the two measurements. The preoperative length of the syrinx did not change significantly when compared with the postoperative (5 vs. 1; p=0.052), nevertheless, the median transverse diameter of the syrinx did improve significantly after the surgery (0.75 vs. 0.32, p=0.03). Conclusions: : Our study supports the safety and effectiveness of ETV for the management of children with CSF disorders, ventriculomegaly and associated CIM.