A challenging case of endoscopic third ventriculostomy.

Area of Science:

• Neurosurgery
• Pediatric Neurosurgery
• Hydrocephalus Management

Background:

• Endoscopic third ventriculostomy (ETV) is increasingly used for hydrocephalus associated with Myelomeningocele and Chiari type II malformation.
• It serves as an alternative to shunting, particularly after shunt malfunction or in post-infectious hydrocephalus.
• Success rates for ETV range from 50-60%, with failures often linked to anatomical complexities or scarring.

Observation:

• A case of a 5-year-old boy with myelomeningocele and recurrent shunt malfunctions is presented.
• The patient had a history of meningitis and multiple shunt revisions, developing a large peritoneal cyst.
• MRI revealed significant hydrocephalus with a trapped, septated third ventricle.

Findings:

• Endoscopic third ventriculostomy was chosen over ventriculoatrial shunting, aiming for shunt independence.
• The procedure was technically successful in achieving short-term shunt independence, despite complex anatomy.
• The patient experienced a technically and clinically successful short-term outcome but later died from unrelated postoperative complications.

Implications:

• ETV can be a successful alternative to shunting in complex hydrocephalus cases.
• Careful patient selection and experienced surgical teams are essential due to challenging anatomy.
• While ETV offers potential shunt independence, risks and outcomes must be individualized.