J Pediatr Neurol 2006; 04(04): 221-232
DOI: 10.1055/s-0035-1557343
Original Article
Georg Thieme Verlag KG Stuttgart – New York

Endoscopic third ventriculostomy for the treatment of hydrocephalus: An alternative to shunting

Pulak Ray
a  Division of Pediatric Neurosurgery, The Johns Hopkins University, Baltimore, USA
,
George I. Jallo
a  Division of Pediatric Neurosurgery, The Johns Hopkins University, Baltimore, USA
,
Richard Y.H. Kim
a  Division of Pediatric Neurosurgery, The Johns Hopkins University, Baltimore, USA
,
Bong-Soo Kim
b  Department of Neurosurgery, Temple University Hospital, Philadelphia, USA
,
Sean Wilson
c  Department of Medicine, Yale University, Connecticut, USA
,
Karl Kothbauer
d  Department of Neurosurgery, Katonsspital Luzern, Luzern, Switzerland
,
Rick Abbott
e  Department of Neurosurgery, Montefiore Medical Center, New York, USA
› Author Affiliations

Subject Editor:
Further Information

Publication History

16 March 2006

19 May 2006

Publication Date:
30 July 2015 (online)

Abstract

Endoscopic third ventriculostomy (ETV) is a common alternative method for the management of hydrocephalus in selected patients. A retrospective chart review was conducted to review our experience with ETV for patients with a variety of causes for hydrocephalus. A total of 67 children with median age of 10.8 years (range= 8 weeks to 21 years) underwent 76 ETVs from July 1992 to June 2003. Two procedures were abandoned due to anatomical distortion. The medical records, operative reports, and imaging studies, were retrospectively reviewed with regard to outcome, complications and patency rate. Treatment failure was defined as the need to shunt the patient within 4 weeks of performing the ETV. The overall success rate was 83% with a mean follow-up 40.8 months. Nine patients underwent 11 repeat ETVs at an average interval period of 24 months with a patency rate of 90% following the second procedure. Ten of eleven patients who underwent re-ETV were ultimately shunt-independent. The highest success rates were achieved for obstructive hydrocephalus from midbrain/tectal tumor (100%, n = 4), pineal tumor (100%, n = 3), intraventricular tumor or cyst (100%, n = 2), and post-infectious hydrocephalus (100%, n = 1). Lower patency rates were noted in patients with Chiari malformation (0%, n = 1) and posterior fossa tumors (63%, n = 8). Due to the efficacy of ETV, it should be considered as the primary procedure, rather than ventricular peritoneal shunts, in carefully selected children. The reliability rate is dependent upon the age and etiology of hydrocephalus.