Endoscopic Third Ventriculostomy plus Valveless Catheter in the Treatment of Low-Pressure Hydrocephalus

To evaluate the outcomes in low-pressure hydrocephalus (LPH) following an endoscopic third ventriculostomy, and placement of a valveless ventriculoperitoneal or ventriculoatrial shunt catheter.

This novel surgical technique was assessed in a prospective case series at a single center between December 2020 and December 2022. Patients were selected for the hybrid procedure based on the Pang?Altschuler diagnostic criteria for LPH. Those with normal or high-pressure hydrocephalus or less than six months of follow-up were excluded. All patients were evaluated clinically (Karnofsky performance status [KPS]) and radiologically (standardized set of images) in the preoperative and postoperative period, and their outcome was categorized as excellent, temporary improvement, or poor.

This case series comprised 16 patients. The mean postoperative improvement in KPS was 56 points. All patients showed improved KPS. All follow-up scans showed radiological improvement. System dysfunction and the need for a shunt with a valve were detected in 18.75% of cases (n=3). The outcome was excellent in 81.25% of cases (n=13), and temporary improvement in 18.75% (n=3).

The presented series demonstrated that the hybrid procedure effectively treats LPH and has minimal number of complications.