Non-communicating (obstructing) hydrocephalus

[rnature1]

Dear neurosurgers,

My girlfriend is 24 years old and is a citizen of Slovak Republic, but we are living at Czech Republic. She was
diagnosed as non-communicating (obstructing) hydrocephalus.
What is better? Shunt or third ventriculostomy? Neurosurgers
from Czech Republic have urged third ventricolostomy but
neurosurgers from Slovak Republic (where she have a health
insurance) indicate only the shunt operation, although the
third ventriculostomy could done there. Slovak neurosurgers
declined the third ventriculostomy.
Neurosurgers at Slovak Republic operate third ventriculostomy
only at neurosurgery of Derer Hospital in Bratislava but this
hospital is indebted.
They don't allow the operation of third ventriculostomy at Czech
Republic although exists international contract between
Czech Republic a Slovak Republic. This contract say that
Slovak citizen can be operate in Czech Republic when Slovak
hospitals doesn't have such technical instrumentation or
neurosurgers.
What can we do?
What is the best?
Thanks a lot
                Robert Reich

[kacie]

Hi!  I have recently been diagnosed with Aqueductal Stenosis, and in my research have found that Shunts sound very risky... They can become infected, disloged, clogged, rejected by the body, they can over drain the fluid, underdrain... Essentially, there are many problems which may lead to repeat shunt sergery.  If your girlfriend is able to get the ETV I would suggest you look closely at the operation and learn everything you can about it too.  It is possible that with ETV, she could remain shunt free!  If you want to do more research, you can go to PubMed and search the website for medical journal articles relating to her diagnosis... Even the tidbits in the abstracts are helpful.  Good luck!  kacie

[CCF-Neuro-M.D.-JT]

There is varying data in the medical literature regarding what is the best therapy for hydrocephalus in terms of ventriculostomy versus shunt. However, a number of studies agree that there are certain features of the hydrocephalus that are important in determining success rate of a ventriculostomy. 1.problem is due to aqueductal stenosis
2.problem is due to tectal tumor
3.three ventricles as opposed to 4 are enlarged on an MRI/CT

If any of these three situations pertain to your girlfriend, then she may do well with a ventriculostomy. However, keep in mind that while some studies may show that patients do ok with a ventriculostomy, others show only a 50% success rate, with the remaining 50% requiring a shunt in the end due to the failure of the ventriculostomy. This is a complex decision that needs to be made with a neurosurgeon who has all the information regarding your girlfriends condition.

If indeed a third ventriculostomy is deemed the best option for her, it sounds like you will need medical and political help in getting the surgery done. Consider getting a strong letter from the Czech surgeons detailing why it' s best for her to get this procedure over a shunt and taking it to either an experienced surgeon in the slovak republic who is willing to do the case or someone who has governmental ties/power to allow you to have the surgery done in the Czech republic. Finally consider getting a lawyer to help. Good luck.