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Updated: Nov 13, 2025
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Endoscopic Third Ventriculostomy in Failed Ventriculoperitoneal Shunt in Pediatric Population
Ajay Choudhary1, Shivender Sobti2, Sourabh Zambre3
1Department of Neurosurgery, ABVIMS and Dr. RML Hospital, New Delhi, India.
Insights
Endoscopic third ventriculostomy (ETV) is an effective alternative treatment for pediatric hydrocephalus, especially after ventriculoperitoneal (VP) shunt failure. This procedure offers a viable option for children, regardless of age, who have experienced multiple shunt malfunctions.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Neurology
Background:
- Ventriculoperitoneal (VP) shunts are common for pediatric hydrocephalus but have high complication and revision rates.
- Endoscopic third ventriculostomy (ETV) presents a potential alternative to mitigate these VP shunt-related issues.
Purpose of the Study:
- To evaluate the efficacy of ETV as an alternative treatment for pediatric hydrocephalus following VP shunt failure.
- To determine factors influencing ETV success in pediatric patients with hydrocephalus.
Main Methods:
- Retrospective review of 36 pediatric patients with failed VP shunts treated with ETV between November 2010 and January 2016.
- Patients were categorized by age (<1, 1-10, 10-18 years), hydrocephalus type, and prior shunt revision history.
- Success was assessed based on clinical outcomes with a minimum 3-month follow-up.
Main Results:
- ETV demonstrated higher success rates in non-communicating hydrocephalus (84.2%) compared to communicating hydrocephalus (52.9%).
- Patients with two or more prior shunt malfunctions had a higher ETV success rate (86.7%) than those with only one malfunction (57.1%).
- Age and sex were not significant factors in ETV success.
Conclusions:
- Endoscopic third ventriculostomy (ETV) is an effective alternative treatment for pediatric hydrocephalus, particularly in cases of VP shunt failure.
- Patient age is not a contraindication for considering ETV in this population.
Introduction:
Ventriculoperitoneal (VP) shunt malfunction is common in pediatric age group patients. There is a high complication rate and revision rate of VP shunt. Endoscopic third ventriculostomy (ETV) can alleviate these complications and can act as an effective alternative for the treatment of hydrocephalus in this age group of patients.
Materials And Methods:
The authors retrospectively reviewed the management and outcome of 36 failed VP shunts in pediatric patients for the treatment of hydrocephalus. The surgeries were performed between November 2010 and January 2016 in a tertiary care hospital. The minimal follow-up period was 3 months. We divided the patients into the following age groups: <1 year (eight infants), 1-10 years (18 children), and 10-18 years (10 children). The success of the procedure was determined by age, sex, type of hydrocephalus, and the number of shunt revisions and malfunction before ETV. Children with different age (P = 0.839) and sex group did not show any significant data (P = 0.798). Children with communicating hydrocephalus had a success rate of 52.9% (17 patients), and children with noncommunicating hydrocephalus had a success rate of 84.2% (19 patients). The success rate in children with only one shunt malfunction was 57.1% (21 patients), whereas in 15 children with two or more shunt malfunctions, the success rate of ETV was 86.7%.
Conclusions:
The authors conclude that ETV is an effective alternative for the treatment of hydrocephalus in children. Age does not present a contraindication for ETV in failed VP shunt.
