Assessing efficacy of endoscopic ventriculocisternostomy using a semi-rigid needle endoscope in сhildren with hydrocephalus and concomitant drug-resistant epilepsy: results of CT brain perfusion and time-frequency EEG analysis

Abstract

Background. The probability of seizures after endoscopic surgical treatment of hydrocephalus may comprise up to 9.5%, therefore accounting for a need to find solutions for alleviating the surgical trauma to the brain. One option to this problem might be based on using “seamless” neurosurgery, particularly endoscopes with a minimal outer sheath diameter (needle endoscopes, shunt endoscopes).Objective: to evaluate major outcomes of surgically treated epilepsy, cerebral haemodynamics and electroencephalogram (EEG) in children with hydrocephalus and concomitant drug-resistant epilepsy before and after endoscopic ventriculocysternostomy of the third ventricular floor by using a semi-rigid needle endoscope.Material and methods. In the early and remote postoperative periods, no epileptic seizures were observed in 57.1% of subjects (Engel Class I). Mean seizure frequency decreased from 12.9±6.1 to 0.82±0.31 per month (p<0.01). A significant decline in slow-wave amplitude and the paroxysmal index from 19.1±2.5% to 6.9±1.7% (p<0.01) were observed, as well as improvement of cerebral hemodynamics in the form of increased mean cerebral blood flow by 29.1±4.3% (p<0.01), mean circulating blood volume by 22.4±5.27% (p<0.05) and decreased mean transit time by 12.8±2.5% (p<0.05).Results. In the early and remote postoperative periods, no epileptic seizures were observed in 57.1% of subjects (Engel Class I). Mean seizure frequency decreased from 12.9±6.1 to 0.82±0.31 per month (p<0.01). A significant decline in slow-wave amplitude and the paroxysmal index from 19.1±2.5% to 6.9±1.7% (p><0.01) were observed, as well as improvement of cerebral hemodynamics in the form of increased mean cerebral blood flow by 29.1±4.3% (p><0.01), mean circulating blood volume by ><0.01). A significant decline in slow-wave amplitude and the paroxysmal index from 19.1±2.5% to 6.9±1.7% (p<0.01), mean circulating blood volume by 22.4±5.27% (p<0.05) and decreased mean transit time by 12.8±2.5% (p><0.05).