Hypothalamic-pituitary Effects After Endoscopic Third Ventriculostomy
Hypothalamic-pituitary Effects After Endoscopic Third Ventriculostomy
Background: Endoscopic third ventriculostomy (ETV) is a standard procedure for the treatment
 of obstructive hydrocephalus in children and adults. Perforation of the third ventricle floor
 which is part of the hypothalamic-pituitary neuronal network is the key of this surgical
 procedure.

 Purpose: There are no prospective data available about the endocrine effects after ETV in
 children and adults. The principal aim of this prospective study is to evaluate the
 variability of hypothalamic-pituitary hormones and clinical effects in children and adults
 after ETV in order to plan a multicentric study.
Introduction Endoscopic third ventriculostomy (ETV) is a standard procedure for the treatment
 of obstructive hydrocephalus in children and adults. Perforation of the third ventricle floor
 which is part of the hypothalamic-pituitary neuronal network is the key of this surgical
 procedure. Single patients with endocrine or electrolyte abnormalities after ETV have been
 reported in children or adults. So far there are no prospective data available about the
 endocrine effects after ETV.

 Materials and methods 40 patients (10 children, 30 adults) with obstructive hydrocephalus and
 inclusion criteria will undergo ETV in our neurosurgical department. Complete
 hypothalamic-pituitary hormonal evaluation will be done, in children and adults, before the
 procedure and at 3 and 12 month after ETV. At 3 month, a brain MRI, with
 hypothalamic-pituitary specifics sequences, will be performed and compared to the
 preoperative one. Follow up will be at 3 and 12 month after ETV.

 Interventions: ETV is performed under general anesthesia with a rigid endoscope. Perforation
 is made just behind the clivus, halfway between the infundibulum and the mammillary bodies in
 the midline using a monopolar electrode, followed by dilatation with an inflated balloon
 catheter. In our department, this procedure is performed only by 2 senior surgeons.

 Number of subjects: 40 patients: 10 children, 30 adults. Statistical analysis: stratified
 analysis.
Inclusion Criteria:

 -  all patients over 6 months old with obstructive hydrocephalus who are referred for
 planned endoscopic third ventriculocisternostomy

 Exclusion Criteria:

 -  MRI contraindication, non obstructive hydrocephalus, life expectancy inferior of 3
 months, ETV in emergency, hydrocephalus aetiology interaction with
 hypothalamic-pituitary hormones, hydrocephalus already treated, basilar artery
 malformations, to be allergic to tetracosactide (synacthene) and to benserazide
 (Levodopa).