Endoscopic Third Ventriculostomy: Outcome Analysis in 636 Procedures

Objective: Although endoscopic third ventriculostomy (ETV) has been accepted as a procedure of choice for the management of obstructive hydrocephalus, the outcome of this treatment could be controversial with regard to age, cause, and long-term follow-up results. The aim of this study was to present our ETV experience and to assess the risk of failure associated with these factors.Methods Between: 1999 and 2014, 636 ETVs were performed in 607 patients (279 patients < 18 years of age) with hydrocephalus at the University Hospital of Toulouse. Failure of ETV was defined as cases requiring any subsequent surgical procedure for CSF diversion.Results: Tumors (47%) and primary aqueductal stenosis (18%) were the most common causes of hydrocephalus. The mean age was 34 yrs (range 2 days – 88 yrs). The mean follow-up period was 35 months (range 6–156 months), and the overall success rate was 73% (466 of the 636 procedures). Patients < 6 months of age had a 5-fold increased risk of ETV failure than older patients. Neonatal hemorrhage, infection-related hydrocephalus, and idiopathic chronic hydrocephalus had a higher risk of failure than other causes. The best success rates were obtained in pineal tumors (93% of cases), posterior fossa tumors (89%), supra sellar arachnoid cysts (79%), aqueductal stenosis (77%) and cerebellar hematomas (73%). Most failures (85%) occurred within 6 months of the initial procedure. The overall morbidity rate was 8.8%, although most complications were minor. Conclusions: Endoscopic third ventriculostomy is a safe procedure and an effective treatment option for obstructive hydrocephalus. Factors indicating potential poor ETV outcome seem to be very young children, neonatal hemorrhage-related, chronic hydrocephalus in adults, and infection-related hydrocephalus.