Опыт хирургического лечения осло жненных форм гидроцефалии у детей с дисфункцией ликворошунтирую щей системы

Objective. To improve the surgical treatment outcomes at patients with occlusive hydrocephaly in case of liquor-shunt system disfunction by differentiated usage of endoscopic ventriculocisternostomy of III ventricle fundus (EVCS III).

 Material and methods. We have analyzed data of 60 patients with liquor-shunt system disfunction. All patients were divided into two groups. Basic group included 32 patients with liquor-shunt system disfunction underwent EVCS III. Comparison group included 28 patients underwent conventional treatment of shunt disfunction – revision and/or reconstruction of shunt system. Groups were uniform concerning some basic characteristics (age, sex, duration of shunt-addiction, number of re-operations)/ All patients in basic group were operated on using neuroendovideoscopic devices: rigid and semi-rigid endoscopes, flexible operated fiberscope.

Results. All patients were operated on without any intraoperative complications and stood well in postoperative period. There were no lethal cases. Surgery treatment success after EVCS III was lower (87,8%) in earliest postoperative period comparing with comparison group (100%) (р<0,01) due to early disfunctions after endoscopic operations. However successful results in delayed postoperative period in basic group amount to 78,8% comparing with 53,6% (p<0,05) in comparison group due to greater amount of repeated liquor-shunt systems disfunctions in comparision group. Comparative analysis revealed that EVCS III is more effective method (100%) for hydrocephaly treatment in the case of Sylvian aqueduct occlusion and liquor-shunt system disfunction comparing with conventional treatment (33,3%) (p<0,001). Though efficacy of conventional treatment of shunt disfunction with revision and/or reconstruction of shunt system among patients with occlusion at the level of IV ventricle and liquor-shunt system disfunction compound 100% comparing with efficacy of EVCS III in earliest (75% (p<0,05)) and delayed (50%(p<0,005)) postoperative periods.

Conclusion. Endoscopic ventriculocisternostomy of III ventricle fundus is alternative therapy method for treatment of occlusive hydrocephaly in the case of liquor-shunt system occlusion. The usage of this method allows achieving shunt-independency at 78,8% of patients in delayed postoperative period and at 45,5% of patients (0 % in basic group) after total removal of liquor-shunt system causing minimal numbers of complications (3,0% comparing with 17,9%), that leads to significantly improvement of patients’ life quality and increase of social adaptation level.