Tercerventriculo-cisternostomía microquirúrgica. Experiencia personal y descripción de acceso micropterional como alternativa a acceso keyhole supraorbitario

Abstract

Hydrocephalus is a frequent pathology in a neurosurgeon work. It can be classified as communicating or non-communicating according to its etiology. Ventriculoperitoneal shunt is the standard treatment for this pathology, however, it is associated with complications such as obstruction and/or infection. For non-communicating (or obstructive) hydrocephalus, the third-ventricle cisternostomy (TVC) is an alternative for its treatment. This technique is performed endoscopically with good results and low complications. In patients with obstructive hydrocephalus where endoscopy cannot be performed due to anatomical characteristics of the patient, there are reports of performing this procedure using a microsurgical technique, classically via a supraorbital keyhole approach. Between 2015 and 2018, a microsurgical TVC was performed in 17 patients with obstructive hydrocephalus. The technique had a 82% success rate and no postoperative complications attributable to surgery. The 82% was performed through a micropterional approach (described in this article), 12% through supraorbital keyhole and 6% through a mini-pterional. The microsurgical TVC could be considered an alternative for the management of obstructive hydrocephalus in cases where endoscopy can not be performed. The effectiveness rate of the present series is comparable to that of endoscopic TVC. More publications are needed to compare the micropterional versus the supraorbital keyhole approach benefits.