الفهرس 
Introduction and Aim of the workOnly 14 pages are availabe for public view
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Abstract
The introduction of valve regulated shunts at the early 1950 revolutionized the treatment of hydrocephalus by ventriculoperitoneal or ventriculo atrial shunts. However, despite the major improvements in shunt systems and operative techniques, high failure rates and numerous complications made it better to avoid shunts whenever possible.
The development of the new neuroendoscopes with improved optical features and easy handling made endoscopic third ventriculo-stomy a successful procedure with no or only few complications.
E.T.V.if succeseded, the subsequent risks of CSF shunt infection and malfunction are avoided, and so it can be considered as the first choice for treating selected cases of non communicating hydrocephalus and gives a good chance for a considerable number of patients to have a shunt free life.
However, even in expeirenced hands the surgical risks of ETV are greater than those of routine CSF shunt placement. Also even with careful patient selection , this therapy will fail in a certain percentage of patients, and these patients will still require shunt placement.
So up to now extracranial C.S.F diversion by using shunt devices/with all its complications/ is still considered the main therapeutic option for all types of hydrocephalus .
Recommendation
Widening the selection criteria to include all patients with posterior fossa tumors. pineal region tumors , chiary malformation and associated spinal dysraphysim with no age restriction may give many patients a chance to be shunt free.
Long term follow up is needed to detect late failure of E.T.V.and improve its cost effectiveness ratio.
In those patients who are not suitable for E.T.V every effort should be done to avoid the risk factors that may cause shunt complications.
Summary
Hydrocephalus is one of the more frequent pathology facing neurosurgeons.
Its incidence is 3-4 /1000 live births at infantile age group, and the adult hydrocephalus represents about 40 % of total cases of hydrocephalus.
Up to now there are no ideal treatment for hydrocephalus.
This study compares the success rate and complications of extracranial shunts as a conventional treatment and the recently redeveloped E.T.V. in treatment of non- communicating hydrocephalus.
Patients were divided into 2 groups
group A were selected to have primary aqueduct stenosis and were divided into 2 subgroups according to the method of treatment.
group A1 was treated with E.T.V.
Success occurred in 17 of the 26 patients included in this group 65.4 % up to 3.5years post operatively.
Failure occurred in 9 patients 34.6%. Of the faild pationts 44% were below 6 months age. No major operative complication were detected and those with failed procedures had a successful shunt operation except for 1 patient who died of ventriculitis(3.8%).
group A2 was treated with ventriculoperitoneal shunt insertion.
Success occurred in 31 of the 55 patients included in this group (56.4%) up to 3.5years post operatively.
Complications occurred in 24 patients(43.6%). Of the complicated pationts(62.5%)were below 6 months age. No major operative complication were detected and those with complicated procedures had a shunt revision operations.
Complications were shunt malfunction in 9 patient (16.3%) shunt infection in 12 patient (21.2%) and subdural hematoma in 2 patients (3.6%).
8 patients died due to sequelae of shunt complications (14.5%)
group B included patient with secondry non-communicating hydrocephalus due to different obstructing causes.
They were divided into 2 subgroups according to the method of treatment.
group B 1 was treated with E.T.V.
Success occurred in 10 of the 12 patients included in this group (83.3%) up to 3.5years post operatively.
Failure occurred in 2 patients (16.7%)
One major operative complication was detected it was intra operative arterial bleeding, and theother failed patient had a successful shunt operation
One patient died after intraoperative massive bleeding(8.3%).
group B2 was treated with ventriculoperitoneal shunt insertion.
Success occurred in 32 of the 37 patients included in this group (86.5%) up to 3.5years post operatively.
Complications occurred in 5 patients(13.5%). No major operative complication were detected and those with complicated procedures had a shunt revision operations.
The complications occurred was shunt malfunction in all the 5 complicated patients (13.5%). Shunt infection did not be detected in this group.
1 patient died due to sequelae of shunt complications(2.7 %) and 8 patients died from other unrelated causes.
This study needs further follow up with increasing in the patient treated by E.T.V. by widening of the selection criteria to include other causes of obstructive hydrocephalus and it concludes that E.T.V. can be first option in treating selected cases of non communicating hydrocephalus yet conventional shunts although all its complications still considered the main therapeutic option for all cases of hydrocephalus.