Background and Objectives: Ventriculoperitoneal Shunt (VPS) and Endoscopic Third Ventriculostomy (ETV) are both gold standard procedures to reduce intracranial pressure (ICP) in patients with obstructive hydrocephalus, which often results in papilledema. This comparative study was carried out at the Department of Neurosurgery of Dhaka Medical College and Hospital to compare the efficacy of VPS and ETV in the resolution of papilledema in 18 patients with obstructive hydrocephalus. Materials and Methods: The success of CSF diversion was evaluated by a decrease in retinal nerve fiber layer (RNFL) thickness by optical coherence tomography (OCT) and modified Frisen grading of papilledema at the same time. The statistical analyses were carried out by using paired sample t test and the Spearman\'s correlation coefficient test. The level of significance (p value) was set at <0.05. Results: After 7 days, both VPS and ETV were able to reduce RNFL thickness of both eyes with a p value = 0.016 (right eye) and 0.003 (left eye) in group A (VPS) and with a p value <0.001 (both eyes) in group B (ETV). Change of Frisen grading after CSF diversion was not satisfying for both the procedures with p value > 0.05. Further, the inter-group comparison between VPS and ETV showed no difference in decreasing RNFL thickness and modified Frisen grading (p value = 0.56). Conclusion: VPS and ETV procedures both appear very efficient in treating obstructive hydrocephalus, which in turn reduces papilledema in these patients. This paper is preliminary and requires further work.

UNASSIGNED: Management of obstructive hydrocephalus is an important issue for the reduction of mortality and morbidity.
UNASSIGNED: The aim of the present study was to assess the early surgical outcome of endoscopic third ventriculostomy (ETV) in the management of obstructive hydrocephalus.
UNASSIGNED: This randomized controlled trial was conducted at the Department of Neurosurgery at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, from April 2009 to September 2010 for 1½ years. All patients presenting with obstructive hydrocephalus with the obstruction at or distal to the third ventricle and age 6 months and above were included in the study population. All the patients were divided into two groups named as Group A (experimental group) who were treated with ETV and Group B (control group) who were treated with ventriculoperitoneal shunt (VPS). The early surgical outcome was defined as outcomes within 1 month following surgical interventions. Pre- and post-operative outcomes of this study were measured.
UNASSIGNED: A total number of sixty patients were recruited from which thirty patients were in Group A and the rest thirty patients were in Group B. The mean postoperative head circumference was 43.4 ± 7.1 cm and 47.8 ± 5.6 cm in VPS and ETV surgery, respectively (P ≤ 0.01). Postoperative vomiting was improved 24 (92.3%) in Group A and 23 (88.5%) in Group B (P < 0.05). Postoperative infection occurred in 1 (3.3%) case in Group A and 8 (26.7%) cases in Group B (P < 0.05). The success of the operation in Group A and Group B included 25 (83.3%) cases and 12 (40%) cases, respectively (P < 0.05).
UNASSIGNED: Early surgical outcome following ETV is better than VPS surgery in patients with obstructive hydrocephalus.

BACKGROUND: Vertebrobasilar dolichoectasia (VBD) is a clinical entity associated with ischemic stroke, compression of cranial nerves or brainstem, and hydrocephalus. There have been relatively few studies following the progression of VBD in patients presenting with a variety of diverse clinical features.
METHODS: Here, we report a case study of a male with progressive VBD who was followed from November 2012 to December 2016. The patient had diagnosed hypertension for several years and suffered from left peripheral facial paralysis, recurrent ischemic attacks in the brainstem and cerebellum, obstructive hydrocephalus and frequent pneumonia. A series of cranial CT and multi-modal MRI scans were performed to explore the brain imaging features of the patient during follow-up.
CONCLUSIONS: The presented case study suggests that aging, uncontrolled hypertension, arterial dissection and infection may contribute to the exacerbation of VBD and recurrent ischemic stroke.

OBJECTIVE: The goal of this study was to determine the value of the 3D sampling perfection with application-optimized contrasts using different flip-angle evolutions (3D-SPACE) technique in the evaluation of endoscopic third ventriculostomy (ETV) patency.
METHODS: Twenty-six patients with ETV were examined using 3-T MRI units. Sagittal-plane 3D-SPACE with variant flip-angle mode, 3D T1-weighted (T1W), and 3D heavily T2-weighted (T2W) images were obtained with isotropic voxel sizes. Also, sagittal-axial plane phase-contrast cine (PC)-MR images were obtained. The following findings were evaluated: diameters of stoma and third ventricle, flow-void sign on 3D-SPACE and PC-MR images, integrity of the third ventricle on heavily T2W images, and quantitative PC-MRI parameters of the stoma. Obtained sequences were evaluated singly, in combination with one another, and all together.
RESULTS: The mean area, flow, and velocity values measured at the level of stoma in patients with patent stoma were significantly higher than those measured in patients with closed stoma (p < 0.05). There was significant correlation among PC-MRI, 3D-SPACE, and 3D heavily T2W techniques regarding assessment of ETV patency (p < 0.001). The 3D-SPACE technique provided the lowest rate of ambiguous results.
CONCLUSIONS: The 3D-SPACE technique seems to be the most efficient one for determination of ETV patency. The authors suggest the use of 3D-SPACE as a stand-alone first-line sequence in addition to routine brain MRI protocols in assessing patients with ETV, thereby decreasing scan time and reserving the use of a combination of additional sequences such as PC-MRI and 3D heavily T2W images in suspicious or complex cases.

OBJECTIVE: In this study, we were assessing the outcome of Endoscopic Third Ventriculostomy (ETV) in infants below six months of age in cases of congenital obstructive hydrocephalus.
METHODS: The study was done prospectively on eight cases of obstructive hydrocephalus in infants younger than six months of age to assess the success rate of ETV as a primary treatment for hydrocephalus in this age group; in cases of evident failure, a ventriculo-peritoneal (VP) shunt was applied.
RESULTS: Despite eliminating the factors suggested as causes of ETV failure in infants below six months; the type, as with the communicating hydrocephalus, the thickness of the third ventricular floor, history of previous intracranial hemorrhage or central nervous system infection, still the success rate did not exceed 12.5%.
CONCLUSIONS: The complication rate following ETV was low in comparison to the high frequency (20-80%) and seriousness of the possible postoperative complications following VP shunt with a significant decrease in the quality of patients\' lives. Hence the decision-making as well as the parental counselling were in a trial to estimate the ETV success or the need to perform a shunt in the treatment of obstructive hydrocephalus.