The long-term outcomes of endoscopic third ventriculostomy in pediatric hydrocephalus, with an emphasis on future intellectual development and shunt dependency

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The goal of this study was to clarify the long-term outcome of endoscopic third ventriculostomy (ETV) in pediatric hydrocephalus in light of the ETV Success Score (ETVSS), shunt dependency, and intellectual development.


The authors retrospectively analyzed pediatric patients with hydrocephalus who underwent ETV between 2002 and 2012 and who were followed for longer than 5 years as a single-center cohort. The data of the patients’ pre- and postoperative status were collected. The relationships between ETVSS and the full-scale IQ as well as shunt dependency were analyzed. The usefulness of ETVSS for repeat ETV and the change of radiological parameters of ventricle size before and after ETV were also analyzed. The success of ETV was defined as no requirement for further CSF diversion procedures.


Fifty ETVs were performed in 40 patients. The average ETVSS was 61 and the success rate at 6 months was 64%. The mean follow-up was 9.9 years (5.2–15.3 years), and the long-term success rate of ETV was 50%. The Kaplan-Meier survival curve continued to show a statistically significant difference among patients with a low, moderate, and high ETVSS, even after 6 months (p = 0.002). After 15 months from the initial ETV, no patients required additional CSF diversion surgery. There was no statistical significance between ETVSS and the long-term full-scale IQ or shunt dependency (p = 0.34 and 0.12, respectively). The radiological improvement in ventricle size was not associated with better future educational outcome.


The ETVSS was correlated with the long-term success rate. After 15 months from the initial ETV, no patients required an additional CSF diversion procedure. The ETVSS was not considered to be correlated with long-term intellectual status.

ABBREVIATIONS ETV = endoscopic third ventriculostomy; ETVSS = ETV Success Score; FOHR = fronto-occipital horn ratio; ΔFOHR = change of FOHR; FSIQ = full-scale IQ; HCP = hydrocephalus; mTVW = maximal third ventricle width; ΔmTVW = change of mTVW.

Article Information

Correspondence Hideki Ogiwara: National Center for Child Health and Development, Tokyo, Japan.

INCLUDE WHEN CITING Published online October 12, 2018; DOI: 10.3171/2018.7.PEDS18220.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.



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    Kaplan-Meier curves for resolution of HCP after ETV depending on the 3 subgroups (p = 0.002). Note that 7 cases recurred after 6 months but that no HCP recurred after 15 months from previous ETV. Figure is available in color online only.



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