Endoscopic third ventriculostomy: outcome analysis of 100 consecutive procedures

Endoscopic third ventriculostomy (ETV) has been shown to be a sufficient alternative in the surgical treatment of occlusive hydrocephalus. To elucidate the ongoing discussion of timing, indication, and surgical technique, a retrospective analysis of 100 consecutive ETVs was conducted.

One hundred ETVs were performed in 95 patients (43 female and 52 male patients). Their age ranged from 3 weeks to 77 years (mean age, 36 yr). Hydrocephalus was caused by aqueductal stenosis in 40 patients, space-occupying lesions in 42, and intraventricular or subarachnoid hemorrhage in 8. One patient had postinflammatory hydrocephalus, and four patients had occlusive hydrocephalus of unknown origin. In 33 cases, surgery was performed using stereotactic guidance.

ETV was accomplished in 98 of 100 cases. The overall success rate was 76%. Patients with benign space-occupying lesions and nontumorous aqueductal stenosis had the highest success rates, which were 95 and 83%, respectively. Complications were arterial bleeding in one case, venous bleeding in three cases, intracerebral bleeding in one case, and infection in one case. There were no permanent morbidities or mortalities.

ETV is most effective in treating uncomplicated occlusive hydrocephalus caused by aqueductal stenosis and space-occupying lesions. ETV is still effective in two-thirds of the patients with previous infections or intraventricular bleeding. Patients who have previously undergone shunting and who have occlusive hydrocephalus should undergo ETV at the time of shunt failure, with immediate ligation or removal of the shunt device. In selected cases of distorted anatomy or impaired visual conditions, stereotactic guidance is helpful.