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

Pulak Ray, George I. Jallo, Richard Y.H. Kim, Bong Soo Kim, Sean Wilson, Karl Kothbauer, Rick Abbott

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)221-232
Number of pages12
JournalJournal of Pediatric Neurology
Volume4
Issue number4
DOIs
StatePublished - 2006

Keywords

  • Endoscope
  • Hydrocephalus
  • Outcome
  • Third ventriculostomy

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Clinical Neurology

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