Related Experiment Video
Updated: Jun 18, 2026
Endoscopic Third Ventriculostomy and Pineal Biopsy from a Single Entry Point
Published on: June 28, 2024
Endoscopic third ventriculostomy for obstructive hydrocephalus in children younger than 6 months of age
Hideki Ogiwara1, Arthur J Dipatri, Tord D Alden
1Division of Neurosurgery, Children's Memorial Hospital, Chicago, IL, USA.
Insights
Endoscopic third ventriculostomy (ETV) may be a viable first treatment for infant hydrocephalus. Success rates were higher in infants over 3 months old, suggesting ETV as a potential primary option.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Medical Technology
Background:
- Infantile hydrocephalus outcomes are debated, particularly comparing endoscopic third ventriculostomy (ETV) with shunt placement.
- ETV success rates are generally lower in infants under 2 years old.
Purpose of the Study:
- To assess the feasibility of ETV as a primary treatment for hydrocephalus in infants younger than 6 months.
- To analyze ETV outcomes in this specific pediatric age group.
Main Methods:
- Retrospective analysis of 23 patients under 6 months old treated with ETV between 1994 and 2008.
- Hydrocephalus etiologies included aqueduct stenosis, posthemorrhagic obstruction, myelomeningocele, meningitis, Chiari I malformation, and Dandy-Walker variant.
- ETV success was defined as the absence of subsequent shunt surgery.
Main Results:
- Overall ETV success rate was 34.8% (8 out of 23 patients).
- Success rate was 25.0% in infants <3 months old and 45.5% in those aged 3-6 months.
- Complications included intraventricular hemorrhage, meningitis, and cerebrospinal fluid leak.
Conclusions:
- ETV can be considered a first-line treatment for hydrocephalus in infants under 6 months.
- ETV is particularly promising for infants older than 3 months, offering a potential alternative to shunting.
Purpose:
The outcome of endoscopic third ventriculostomy (ETV) is worse in children younger than 2 years old and especially in infants, and controversies still exist whether ETV might be superior to shunt placement in this age group. We retrospectively analyzed the data of 23 patients younger than 6 months of age treated with ETV and assessed its feasibility as a first choice of treatment for hydrocephalus.
Methods:
Between 1994 and 2008 in our clinic, 23 patients younger than 6 months having presented with obstructive hydrocephalus were treated endoscopically. The etiology of hydrocephalus was congenital aqueduct stenosis in 11 patients, posthemorrhagic obstruction in six patients, myelomeningocele in two patients, postmeningitis in two patients, Chiari I malformation in one patients, and Dandy walker variant in one patient. ETV was considered successful when no shunt operation was needed in the patient.
Results:
ETV was successful in eight patients with regression of intracranial hypertension. In the remaining 15 patients, ventriculoperitoneal shunt implantation was necessary. Total success rate in our group of patients was 34.8%. In patients younger than 3 months of age (n=12), success rate was 25.0%. In patients from 3 to 6 months of age (n=11), success rate was 45.5%. Complication included intraventricular hemorrhage in one patient, meningitis and cerebrospinal fluid leak in one patient, and meningitis in one patient.
Conclusions:
Based on our experience, ETV could be the first method of choice for hydrocephalus in children younger than 6 months of age, especially in patients older than 3 months of age.
