Complications of endoscopic third ventriculostomy

Area of Science:

• Neurosurgery
• Pediatric Neurosurgery
• Neurology

Background:

• Endoscopic third ventriculostomy (ETV) is the preferred initial treatment for noncommunicating hydrocephalus.
• However, ETV is associated with potential risks and complications that require careful consideration.

Purpose of the Study:

• To evaluate the complication rates associated with endoscopic third ventriculostomy (ETV) in a large patient cohort.
• To identify factors influencing complication risk, including etiology and whether the procedure was primary or repeat.

Main Methods:

• Retrospective review of 173 ETV procedures performed between 1998 and 2005 in 155 patients.
• Complications were categorized as intraoperative, early postoperative (<1 month), or late postoperative (>1 month).
• Patient follow-up ranged from 1 to 86 months.

Main Results:

• The overall complication rate was 15.4% per patient and 18% per procedure.
• Complication rates varied significantly by hydrocephalus etiology (P = 0.013).
• Repeat ETV procedures had a substantially higher complication rate (55.5%) compared to initial procedures (10%; P = 0.0001).

Conclusions:

• Endoscopic third ventriculostomy remains the first-line management for noncommunicating hydrocephalus.
• Surgical training, experience, and meticulous technique are crucial for minimizing ETV complications.
• Post-procedure follow-up for ETV patients should be comparable to that for patients with cerebrospinal fluid shunts.