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Endoscopic neurosurgery: report of the first five cases done in Malaysia using the Caemaert-Abdullah method

Farouk A, Abdullah J

Minim Invasive Neurosurg, 1998 Jun;41(2):74-8.
PMID: 9651914

The first endoscopic procedure done in Malaysia using the Caemaert-Abdullah method is reported and the followup results showed an excellent neurosurgical outcome. A 16-year-old girl with an aqueduct stenosis was operated on using a free-hand, computer-assisted endoscopic method where a third ventriculostomy was done. This was the first case being carried out in the Hospital Universiti Sains Malaysia. The next two cases were a suprasellar pituitary cyst in an elderly man and a child with an obstructive hydrocephalus who was previously shunted which became infected. Both endoscopic procedures, extirpation of the cyst using a Nd:Yag laser and a third ventriculostomy, respectively, were done under general anaesthesia in the supine position. Follow-up revealed a transient diabetes insipidus in all three cases up to 48 hours after the operation which resolved spontaneously. The fourth case involved an endoscopic removal of retained ventricular catheter after rectal migration of a shunt in an eight-year-old girl with congenital hydrocephalus. The fifth was a free-hand endoscopy with perforation of multiple brain septae in a ten-month-old baby with hydrocephalus secondary to meningitis. The final outcomes for all the cases were favourable hence we conclude that endoscopic neurosurgery is a safe procedure and hope that more neurosurgeons will continue to use this method, especially for the management of intraventricular cyst and hydrocephalus and especially in South East Asia.

Matched MeSH terms: Endoscopy/methods*
Endoscopic fenestration at the splenial-habenular junctional area for symptomatic cavum and tumor at the foramen of Monro: case reports and anatomical review

Idris Z, Johnson JR, Abdullah JM

J. Neurosurg., 2015 Mar;122(3):504-10.
PMID: 25343181 DOI: 10.3171/2014.9.JNS132683

The splenial-habenular junctional area is an alternative site for neuroendoscopic fenestration to divert CSF flow into the quadrigeminal cistern in cases in which endoscopic third ventriculostomy is not amenable. In some patients with obstructive hydrocephalus, the splenium of the corpus callosum can be elevated from the habenular complex. This exposes the membranous connection between the splenium and habenula, which can be fenestrated to divert the CSF flow into the quadrigeminal cistern. This technique can be performed in patients in whom the foramen of Monro or the third ventricle is blocked by a lesion. Here, the authors present 3 complex cases that were managed by neuronavigation-guided transventricular transcavum endoscopic fenestration of the splenial-habenular junctional area. These cases may increase the knowledge and understanding of the anatomy of this region.

Matched MeSH terms: Endoscopy/methods*
Automated diagnosis of celiac disease by video capsule endoscopy using DAISY Descriptors

Vicnesh J, Wei JKE, Ciaccio EJ, Oh SL, Bhagat G, Lewis SK, et al.

J Med Syst, 2019 Apr 26;43(6):157.
PMID: 31028562 DOI: 10.1007/s10916-019-1285-6

Celiac disease is a genetically determined disorder of the small intestine, occurring due to an immune response to ingested gluten-containing food. The resulting damage to the small intestinal mucosa hampers nutrient absorption, and is characterized by diarrhea, abdominal pain, and a variety of extra-intestinal manifestations. Invasive and costly methods such as endoscopic biopsy are currently used to diagnose celiac disease. Detection of the disease by histopathologic analysis of biopsies can be challenging due to suboptimal sampling. Video capsule images were obtained from celiac patients and controls for comparison and classification. This study exploits the use of DAISY descriptors to project two-dimensional images onto one-dimensional vectors. Shannon entropy is then used to extract features, after which a particle swarm optimization algorithm coupled with normalization is employed to select the 30 best features for classification. Statistical measures of this paradigm were tabulated. The accuracy, positive predictive value, sensitivity and specificity obtained in distinguishing celiac versus control video capsule images were 89.82%, 89.17%, 94.35% and 83.20% respectively, using the 10-fold cross-validation technique. When employing manual methods rather than the automated means described in this study, technical limitations and inconclusive results may hamper diagnosis. Our findings suggest that the computer-aided detection system presented herein can render diagnostic information, and thus may provide clinicians with an important tool to validate a diagnosis of celiac disease.

Matched MeSH terms: Capsule Endoscopy/methods*
Endoscopic trans-septal interforniceal approach for excision of colloid cysts of the third ventricle using the rotational technique

Saleem A, Najibullah M, Shabbir Z, Azab W

Childs Nerv Syst, 2023 Dec;39(12):3373-3379.
PMID: 37173435 DOI: 10.1007/s00381-023-05990-5

Colloid cysts of the third ventricle are benign intracranial lesions that account for 0.5 to 2% of all brain tumors and are even rarer in pediatric population. Dandy was the first to successfully excise a colloid cyst of the third ventricle via a transcortical transventricular approach in 1921. For several decades to follow, the transcortical transventricular and transcallosal microsurgical approaches remained the cornerstone of surgical management of these lesions. With time and refinements in endoscopic equipment and techniques, endoscopic resection of colloid cysts evolved into a currently well-established and appealing minimally invasive alternative to microsurgery. Endoscopic endochannel techniques for colloid cysts of the third ventricle may either be transforaminal or trans-septal interforniceal, depending on the pathoanatomical features of the colloid cyst and its relation to the juxtaposed anatomical structures. The endoscopic trans-septal interforniceal approach is required to access the rare subset of colloid cysts that extend superior to the roof of the third ventricle between the two fornices insinuating themselves between the leaflets of the septum pellucidum. In this article, the surgical technique of the endochannel endoscopic trans-septal interforniceal approach is elaborated upon. A representative case is presented along with an operative video.

Matched MeSH terms: Endoscopy/methods
Effects of nasal lavage with and without mupirocin after endoscopic endonasal skull base surgery: a randomised, controlled study

Ng BHK, Tang IP, Narayanan P, Raman R, Carrau RL

J Laryngol Otol, 2019 Dec;133(12):1059-1063.
PMID: 31774052 DOI: 10.1017/S0022215119002329

BACKGROUND: Nasal lavage with mupirocin has the potential to reduce sinonasal morbidity in endoscopic endonasal approaches for skull base surgery.
OBJECTIVE: To evaluate the effects of nasal lavage with and without mupirocin after endoscopic endonasal skull base surgery.
METHODS: A pilot randomised, controlled trial was conducted on 20 adult patients who had undergone endoscopic endonasal approaches for skull base lesions. These patients were randomly assigned to cohorts using nasal lavages with mupirocin or without mupirocin. Patients were assessed in the out-patient clinic, one week and one month after surgery, using the 22-item Sino-Nasal Outcome Test questionnaire and nasal endoscopy.
RESULTS: Patients in the mupirocin nasal lavage group had lower nasal endoscopy scores post-operatively, and a statistically significant larger difference in nasal endoscopy scores at one month compared to one week. The mupirocin nasal lavage group also showed better Sino-Nasal Outcome Test scores at one month compared to the group without mupirocin.
CONCLUSION: Nasal lavage with mupirocin seems to yield better outcomes regarding patients' symptoms and endoscopic findings.

Matched MeSH terms: Endoscopy/methods
A haemostatic agent delivery system for endoscopic neurosurgical procedures

Waran V, Sek K, Bahuri NF, Narayanan P, Chandran H

Minim Invasive Neurosurg, 2011 Oct;54(5-6):279-81.
PMID: 22278798 DOI: 10.1055/s-0031-1297997

In endoscopic neurosurgery problems with haemostasis due to poor access exist. We have developed a system which allows the delivery of a variety of haemostatic agents in a more efficacious manner. The system has been used successfully in endoscopic skull base surgery and endoscopic surgery within the parenchyma of the brain using tube systems.

Matched MeSH terms: Endoscopy/methods
Objective and subjective changes in voice after endoscopic sinus surgeries in patients with and without nasal polyps

Wong EHC, Chong AW

Am J Otolaryngol, 2019 12 05;41(2):102367.
PMID: 31831185 DOI: 10.1016/j.amjoto.2019.102367

BACKGROUND: Many studies have looked at the effect of functional endoscopic sinus surgeries (FESS) on nasalance, nasal consonant and nasalized vowels. Only two studies investigated the effect of FESS on vocal sound quality and have not found statistically significant changes before and after operations. The aim of this study was to examine the short-term and long-term objective and subjective changes in the vocal quality of patients after FESS, comparing patients with and without nasal polyps.
METHODS: Sixteen patients were recruited for voice analysis during pre-operative, within two weeks and at least three months post-operatively. Subjective questionnaire was used to assess perception of voice changes.
RESULTS: There were no statistically significant changes in the acoustic parameters of patients with nasal polyposis. In patients with CRS without polyps, there was a statistically significant increase in fundamental frequency (F0) in nasal sound during early follow up. The changes in soft phonation index (SPI) values between the two groups were statistically significant during early follow-ups. Only patients with nasal polyposis perceived a subjective change in their voice post-operatively.
CONCLUSIONS: Clinicians should inform all patients, especially voice professionals about the possible effects of endoscopic sinus surgeries on their voice quality.

Matched MeSH terms: Endoscopy/methods*
Fulltext Primary oesophageal Ki (CD30)-positive ALK+ anaplastic large cell lymphoma of T-cell phenotype

Yaakup H, Sagap I, Fadilah SA

Singapore Med J, 2008 Oct;49(10):e289-92.
PMID: 18946602

Primary oesophageal lymphoma is a very rare entity, with fewer than 30 reported cases worldwide. It represents an important cause of dysphagia. Most of the oesophageal lymphomas are diffuse large B-cell type, with only one reported case of anaplastic large cell lymphoma (ALCL) of T-cell phenotype. Primary oesophageal lymphomas that are not associated with an immunocompromised state tend to affect elderly patients. We describe the first case of primary oesophageal Ki (CD30)-positive ALK+ALCL of T-cell phenotype in a 34-year-old immunocompetent woman, who presented with a two-year history of dysphagia. She was treated with chemotherapy and endoscopic oesophageal dilations and stenting, resulting in complete remission of the lymphoma and resolution of the dysphagia. She then underwent autologous peripheral blood haematopoietic stem cell transplantation and remained disease-free two years after the diagnosis.

Matched MeSH terms: Endoscopy/methods
Combined transnasal and transoral endoscopic approach to a transsphenoidal encephalocele in an infant

Tan SH, Mun KS, Chandran PA, Manuel AM, Prepageran N, Waran V, et al.

Childs Nerv Syst, 2015 Jul;31(7):1165-9.
PMID: 25712744 DOI: 10.1007/s00381-015-2667-9

This paper reports an unusual case of a transsphenoidal encephalocele and discusses our experience with a minimally invasive management. To the best of our knowledge, we present the first case of a combined endoscopic transnasal and transoral approach to a transsphenoidal encephalocele in an infant.

Matched MeSH terms: Endoscopy/methods*
Fulltext Transoral endoscopic adenoidectomy: initial experience

Jong YH, Gendeh BS

Med J Malaysia, 2008 Mar;63(1):81-3.
PMID: 18935747 MyJurnal

Adenoidectomy is a common ENT procedure performed in hospitals in Malaysia. Adenoidectomy is indicated in patients with recurrent adenoiditis, nasal obstruction or sleep apnoea secondary to adenoid hypertrophy when conservative management has failed. Over the years, there are advances in the techniques of adenoidectomy, from the conventional transoral to endoscopic transnasal/transoral adenoidectomy. The purpose of this article is to describe the technique and emphasize the advantages of this procedure to that of the conventional technique.

Matched MeSH terms: Endoscopy/methods
Fulltext Bleeding detection in wireless capsule endoscopy videos - Color versus texture features

Pogorelov K, Suman S, Azmadi Hussin F, Saeed Malik A, Ostroukhova O, Riegler M, et al.

J Appl Clin Med Phys, 2019 Aug;20(8):141-154.
PMID: 31251460 DOI: 10.1002/acm2.12662

Wireless capsule endoscopy (WCE) is an effective technology that can be used to make a gastrointestinal (GI) tract diagnosis of various lesions and abnormalities. Due to a long time required to pass through the GI tract, the resulting WCE data stream contains a large number of frames which leads to a tedious job for clinical experts to perform a visual check of each and every frame of a complete patient's video footage. In this paper, an automated technique for bleeding detection based on color and texture features is proposed. The approach combines the color information which is an essential feature for initial detection of frame with bleeding. Additionally, it uses the texture which plays an important role to extract more information from the lesion captured in the frames and allows the system to distinguish finely between borderline cases. The detection algorithm utilizes machine-learning-based classification methods, and it can efficiently distinguish between bleeding and nonbleeding frames and perform pixel-level segmentation of bleeding areas in WCE frames. The performed experimental studies demonstrate the performance of the proposed bleeding detection method in terms of detection accuracy, where we are at least as good as the state-of-the-art approaches. In this research, we have conducted a broad comparison of a number of different state-of-the-art features and classification methods that allows building an efficient and flexible WCE video processing system.

Matched MeSH terms: Capsule Endoscopy/methods*
Fulltext Endoscopic cauterization of the sphenopalatine artery in persistent epistaxis

Harvinder S, Rosalind S, Gurdeep S

Med J Malaysia, 2008 Dec;63(5):377-8.
PMID: 19803294 MyJurnal

The management of epistaxis remains to be a challenging problem for most ENT surgeon especially posterior epistaxis. Most cases are managed by placement of posterior nasal packs or balloons and failure leads to more invasive techniques, involving ligation of the internal maxillary artery. The above management is associated with significant patient complication and morbidity. Endoscopic ligation or cauterization of the sphenopalatine artery has emerged as a viable and minimally invasive alternative. We have performed endoscopic cauterization of nine sphenopalatine arteries in eight patients with no further episodes of epistaxis and complications, with an average follow-up of 25 months. The mean age of the patients was 52.75 years. Fifty percent of the patients had a history of hypertension.

Matched MeSH terms: Endoscopy/methods*
A Novel Method of Nasojejunal Feeding and Gastric Decompression Using a Double Lumen Silicone Tube for Upper Gastrointestinal Obstruction

Tan JH, Sivadurai G, Tan HCL, Tan YR, Jahit S, Hans Alexander M

Surg Laparosc Endosc Percutan Tech, 2020 Apr;30(2):106-110.
PMID: 31923160 DOI: 10.1097/SLE.0000000000000754

BACKGROUND: Provision of enteral nutrition with jejunal feeding in upper gastrointestinal obstruction is highly recommended. Access to jejunum can be obtained surgically, percutaneously, or endoscopically. Our institution routinely and preferentially utilizes a silicone nasojejunal tube that is inserted past the obstruction endoscopically. We use a custom dual channel tube that allows feeding at the distal tip and another channel 40 cm from the tip that enables decompression proximally. This is a report of our experience with this custom nasojejunal tube.
METHODS: This is a prospective observational study of 201 patients who underwent endoscopic nasojejunal wire-guided feeding tube insertions for obstruction of either the esophagus or the stomach including both benign and malignant pathologies between January 2015 to June 2018 in Hospital Sungai Buloh and Hospital Sultanah Aminah, Malaysia. The indications for tube insertion, insertion technique, and tube-related problems were described.
RESULTS: The nasojejunal tube was used to establish enteral feeding in patients with obstructing tumors of the distal esophagus in 65 patients (32.3%) and gastric outlet obstruction in 72 patients (35.8%). There were 54 patients (26.9%) who required reinsertion. The most common reason for reinsertion was unintentional dislodgement, where 32 patients (15.9%) followed by tube blockage 20 patients (10.0%). Using our method of advancement under direct vision, we had only 2 cases of malposition due to severely deformed anatomy. We had no incidence of aspiration in this group of patients and overall, the patients tolerated the tube well.
CONCLUSIONS: The novel nasojejunal feeding tube with gastric decompression function is a safe and effective method of delivery of enteral nutrition in patients with upper gastrointestinal obstruction. These tubes if inserted properly are well tolerated with almost no risk of malposition and are tolerated well even for prolonged periods of time until definitive surgery could be performed.

Matched MeSH terms: Endoscopy/methods
Fulltext Endonasal endoscopic transsphenoidal pituitary surgery for pituitary adenoma: a retrospective analysis of surgical outcome

Sand MS, Gendeh BS, Husain S

Med J Malaysia, 2011 Dec;66(5):443-6.
PMID: 22390098 MyJurnal

The purpose of this retrospective joint rhino-neurosurgical study from January 1998 until September 2009 is to document the demographic data, clinical presentations, radiological findings, approaches and incidence of residual tumour. Forty-seven patients with pituitary adenoma underwent trans-sphenoidal hypophysectomy of which 25 patients with complete medical and radiological data were included in the study. The medical and radiological data were analyzed. There were 12 males and 13 females with age ranging from 17 to 76 years old (mean 49.2). Fourteen of the patients were Chinese, eight Malays and three Indians. Twelve of the patients had functioning tumour of which five each presented with acromegaly and Cushing disease respectively and two with amenorrhoea. The rest of 13 patients had non functioning tumour presenting with visual disturbances. Sixteen of the patients had pituitary macroadenomas and the rest 9 microadenomas. Eighteen patients had undergone transcollumellar trans-sphenoidal hypophysectomy and the rest 7 patients had undergone transnasal transsphenoidal hypophysectomy. About 68.8% of pituitary macroadenomas had residual tumour, compared to only 22.2% of patient with pituitary microadenomas. Radiologically, about 45.5% of residual macroadenoma had suprasellar extension and the majority had spread to suprasellar cistern and carvenous sinus (54.5%). About 16.6% of patients had undergone post operative radiotherapy. In conclusion, this study showed that patient with pituitary macroadenomas had higher incidence of residual tumour compared to pituitary microadenomas.

Matched MeSH terms: Endoscopy/methods*
Endoscopic drainage of empyema of the gallbladder through a concurrent cholecystoduodenal fistula

Lim MS, Davaraj B, Kandasami P

Asian J Surg, 2006 Jan;29(1):55-7.
PMID: 16428103

The duodenum is the most common site of cholecystoenteric fistulation resulting from cholecystitis or empyema of the gallbladder. This rare condition is usually only diagnosed intraoperatively and managed incidentally. This paper presents the endoscopic diagnosis of a case of cholecystoduodenal fistula arising from the late presentation of empyema of the gallbladder and its subsequent drainage through the fistula. As far as we can determine, this is the only reported case of opportunistic drainage of an empyema of the gallbladder through a concurrent cholecystoduodenal fistula.

Matched MeSH terms: Endoscopy/methods*
Endoscopic, endonasal decompression of spinal stenosis with myelopathy secondary to cranio-vertebral tuberculosis: two cases

Puraviappan P, Tang IP, Yong DJ, Prepageran N, Carrau RL, Kassam AB

J Laryngol Otol, 2010 Jul;124(7):816-9.
PMID: 20003599 DOI: 10.1017/S0022215109992271

Tuberculosis can cause extensive osseo-ligamentous destruction at the cranio-vertebral junction, leading to atlanto-axial instability and compression of vital cervico-medullary centres. This may manifest as quadriparesis, bulbar dysfunction and respiratory insufficiency.

Matched MeSH terms: Endoscopy/methods
Single Port Endoscope-Assisted Excision of Forehead Lesions: An Innovative Way of Improving the Optical Cavity

Narayanan V, Jayapalan RR, Singh Sidhu A, Koh KMR

J Craniofac Surg, 2019 2 27;30(3):841-842.
PMID: 30807473 DOI: 10.1097/SCS.0000000000005185

Exophytic lesions involving the face present with an undesirable esthetic deformity and usually necessitate surgical excision. Conventional open excision techniques may lead to scar formation or pigmentation issues postoperatively. Minimally invasive endoscope-assisted surgery will be able to overcome these problems. However, this technique is not widely used because of the limited optical cavity working space, which hinders good visualization. We describe a technique to improve the optical cavity workspace to enable adequate endoscope-assisted surgical excision of forehead lesions in 2 cases. Foley's catheter and ribbon gauze were used in both cases to gain optical cavity workspace. The surgical technique is described in detail. One case had a frontal osteoma, whereas other was a nodular fasciitis of the forehead, confirmed by histology. Postoperative follow-up showed good outcomes at 1 year with no recurrences. Both patients were satisfied with the surgical and cosmetic outcomes. Endoscopic excision of a forehead lesion using the described technique is both safe and reliable. It is an excellent method for excising benign growths over the forehead while being cosmetically acceptable.

Matched MeSH terms: Endoscopy/methods*
Endonasal endoscopic repair of anterior skull-base fistulas: the Kuala Lumpur experience

Gendeh BS, Mazita A, Selladurai BM, Jegan T, Jeevanan J, Misiran K

J Laryngol Otol, 2005 Nov;119(11):866-74.
PMID: 16354338

The purpose of this retrospective study is to determine the pattern of cerebrospinal fluid (CSF) rhinorrhoea presenting to our tertiary referral centre in Kuala Lumpur and to assess the clinical outcomes of endonasal endoscopic surgery for repair of anterior skull base fistulas. Sixteen patients were treated between 1998 and 2004. The aetiology of the condition was spontaneous in seven and acquired in nine patients. In the acquired category, three patients had accidental trauma and this was iatrogenic in six patients (five post pituitary surgery), with one post endoscopic sinus surgery (ESS). Imaging included computed tomography (CT) scan and magnetic resonance imaging (MRI). Endoscopic repair is less suited for defects in the frontal sinuses with prominent lateral extension and defects greater than 1.5 cm in diameter involving the skull base. Fascia lata, middle turbinate mucosa, nasal perichondrium and ear fat ('bath plug') were the preferred repair materials in the anterior skull base, whereas fascia lata, cartilage and abdominal fat obliteration was preferentially used in the sphenoid leak repair. Intrathecal sodium flourescein helped to confirm the site of CSF fistula in 81.3 per cent of the patients. Ninety per cent of the patients who underwent 'bath plug' repair were successful. The overall success rate for a primary endoscopic procedure was 87.5 per cent, although in two cases a second endoscopic procedure was required for closure. In the majority of cases endoscopic repair was successful, and this avoids many of the complications associated with craniotomy, particularly in a young population. Therefore it is our preferred option, but an alternative procedure should be utilized should this prove necessary.

Matched MeSH terms: Endoscopy/methods
Fulltext A comparison of endoscopic and microscopic inlay butterfly cartilage tympanoplasties and their educational utility

Hashim ND, Lee SA, Jang SH, Moon IS

PLoS One, 2020;15(10):e0241152.
PMID: 33125420 DOI: 10.1371/journal.pone.0241152

OBJECTIVES: Inlay butterfly cartilage tympanoplasty (IBCT) is a simple grafting technique. Endoscopy facilitates visualization by eliminating blind spots. We analyzed the outcomes of IBCT using both endoscopic and microscopic approaches, and assessed how trainees perceived the educational opportunities afforded.
MATERIALS AND METHODS: Sixty patients who underwent IBCT were allocated to Group I (n = 30; microscopic IBCT) and Group II (n = 30; endoscopic IBCT) by the dates of their visits. Anatomical success was defined as an intact, repaired tympanic membrane; functional success was defined as a significant decrease in the air-bone gap. Postoperative discomfort was analyzed using a visual analog scale (VAS). Thirteen trainees completed structured questionnaires exploring anatomical identification and the surgical steps.
RESULTS: The surgical success rates were 96.7% in Group I and 100% in Group II. We found no between-group differences in the mean decrease in the air-bone gap or the extent of postoperative discomfort. Significant postoperative hearing improvements were evident in both groups. The mean operative time was shorter when the microscopic approach was chosen (17.7±4.53 vs. 26.13±9.94 min). The two approaches significantly differed in terms of the identification of external and middle ear anatomical features by the trainees, and their understanding of the surgical steps.
CONCLUSION: Both endoscopic and microscopic IBCT were associated with good success rates. The endoscopic approach facilitates visualization, and a better understanding of the middle ear anatomy and the required surgical steps and thus is of greater educational utility.

Matched MeSH terms: Endoscopy/methods*
Stereotactic neuroendoscopic management of hydrocephalus: a three-year follow-up and analysis of Malaysian children with aqueduct stenosis

Abdullah J, Ariff AR, Ghazaime G, Naing NN

Stereotact Funct Neurosurg, 2001;76(3-4):175-80.
PMID: 12378096

The beneficial effects of stereotactic third ventriculostomy versus ventriculoperitoneal shunt were evaluated in 62 paediatric patients and analysed in relation to age, sex, clinical history, presence of meningomyelocele, magnetic resonance imaging measurements of hydrocephalus and third ventricle floor size. The third ventriculostomy were done on 50 patients using the Richard-Wolf Caemaert Endoscope and the Leksell Stereotactic Frame Model G. These patients were operated using the 4-French Fogarty catheter to open the base of the third ventricle. During the same period of study 12 paediatric patients with aqueduct stenosis who were managed by ventriculoperitoneal shunt were included. Both surgical procedures were compared. Statistically univariate analysis revealed that those patient with an age group of more than six months undergoing ventriculostomy had good outcome. Multivariate analysis revealed that past history of haemorrhage and/or meningitis were predictors of poor outcome. Sex, size of lumbar meningocele at birth, abnormal ventricular anatomy or narrow third ventricular floor size were non predictors of bad outcome in these patients. There was no difference in outcome in both the shunt or ventriculostomy group.

Matched MeSH terms: Endoscopy/methods

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