Affiliations: Division of Pediatric Neurosurgery, The Johns Hopkins
University, Baltimore, USA | Department of Neurosurgery, Temple University
Hospital, Philadelphia, USA | Department of Medicine, Yale University, Connecticut,
USA | Department of Neurosurgery, Katonsspital Luzern,
Luzern, Switzerland | Department of Neurosurgery, Montefiore Medical Center,
New York, USA
Note: [] Correspondence: George I. Jallo, M.D., Division of Pediatric
Neurosurgery, The Johns Hopkins University, 600 North Wolfe Street, Harvey 811,
Baltimore, 21287, USA. Tel.: +1 410 955 7851; Fax: +1 410 955 7862; E-mail:
[email protected]
Abstract: Endoscopic third ventriculostomy (ETV) is a common alternative
method for the management of hydrocephalus in selected patients. A
retrospective chart review was conducted to review our experience with ETV for
patients with a variety of causes for hydrocephalus. A total of 67 children
with median age of 10.8 years (range=8 weeks to 21 years)
underwent 76 ETVs from July 1992 to June 2003. Two procedures were abandoned
due to anatomical distortion. The medical records, operative reports, and
imaging studies, were retrospectively reviewed with regard to outcome,
complications and patency rate. Treatment failure was defined as the need to
shunt the patient within 4 weeks of performing the ETV. The overall success
rate was 83% with a mean follow-up 40.8 months. Nine patients underwent 11
repeat ETVs at an average interval period of 24 months with a patency rate of
90% following the second procedure. Ten of eleven patients who underwent
re-ETV were ultimately shunt-independent. The highest success rates were
achieved for obstructive hydrocephalus from midbrain/tectal tumor (100%, n
=4), pineal tumor (100%, n=3), intraventricular tumor or cyst
(100%, n=2), and post-infectious hydrocephalus (100%, n=1). Lower
patency rates were noted in patients with Chiari malformation (0%, n=1)
and posterior fossa tumors (63%, n=8). Due to the efficacy of ETV, it
should be considered as the primary procedure, rather than ventricular
peritoneal shunts, in carefully selected children. The reliability rate is
dependent upon the age and etiology of hydrocephalus.
Keywords: Endoscope, third ventriculostomy, hydrocephalus, outcome
