Burr hole third ventriculo-cisternostomy. An unpopular but effective procedure for treatment of certain forms of occlusive hydrocephalus.

79 cases of obstructive hydrocephalus treated between 1972 and 1983 by burr hole third ventriculo-cisternostomy have been analysed together with the published literature. There were 80% good results in non-tumoral aqueduct stenosis and in hydrocephalus caused by pineal, posterior third ventricle or basal ganglia tumours. The results in hydrocephalus caused by dysrhapic malformations or following meningitis as well as in cases which previously had been treated by shunting procedure were unsatisfactory. Such cases therefore should be excluded from third ventriculo-cisternostomy. In the first mentioned cases the patency of the basal cisterns should be verified beforehand by CSF scintigraphy. Only cases with open cisterns should be selected for third ventriculo-cisternostomy. If these selection guidelines are followed good results can be expected in approximately 90%. Judging from the literature and from our own material the mortality rate is below 1% and the rate of transient neurological deficits about 5%. These complications seem to be avoidable by improved technique. The alternative methods used in the treatment of obstructive hydrocephalus, viz: ventriculo-cardiac or ventriculo-peritoneal shunting, have an overall complication rate higher than 50%. This comparison leads us to recommend third ventriculo-cisternostomy as the treatment of choice for properly selected cases of obstructive hydrocephalus.