Endoscopic third ventriculostomy (ETV) is the treatment of choice for hydrocephalus, but the outcome is dependent on the cause of this disorder, and the procedure remains principally the preserve of pediatric neurosurgeons. The role of ETV in adult patients with hydrocephalus was therefore investigated.
One hundred ninety adult patients underwent ETV for hydrocephalus. Cases were defined as primary ETV (newly diagnosed, without a previously placed shunt) and secondary ETV (performed for shunt malfunctions due to infection or mechanical blockage). Causes of hydrocephalus included tumor, long-standing overt ventriculomegaly (LOVA), Chiari malformation Types I and II (CM-I and -II), aqueduct stenosis, spina bifida, and intraventricular hemorrhage (IVH). Successful ETV was defined as resolution of symptoms with shunt independence. Operative complications and ETV failure rate were investigated according to the causes of hydrocephalus and between the primary and secondary ETV groups.
In the primary group, ETV was successful in 107 (83%) of 129 patients, including those with tumors (52 of 66), LOVA (21 of 24), CM-I (11 of 11 cases), CM-II (8 of 9), aqueduct stenosis (8 of 9), and IVH (2 of 2). In the secondary group, ETV was successful in 41 (67%) of 61 patients and was equally successful in cases of mechanical shunt malfunction (35 of 52 patients) and infected shunt malfunction (6 of 9 patients). The median time to ETV failure was 1.7 months in the primary group and 0.5 months in the secondary group. The majority of ETV failures occurred within the first 3 months, and thereafter, the Kaplan-Meier survival curves plateaued. There were no procedure-related deaths, and complications were seen in only 5.8% of cases.
The success rate of ETVs in adults is comparable, if not better, than in children. In addition to the well-defined role of ETV in the treatment of hydrocephalus caused by tumors and aqueduct stenosis, ETV may also have a role in the management of CM-I, LOVA, persistent shunt infection, and IVH resistant to other CSF diversion procedures.
Abbreviations used in this paper: CM-I = Chiari malformation Type I; CM-II = Chiari malformation Type II; ETV = endoscopic third ventriculostomy; EVD = external ventricular drain; ICP = intracranial pressure; IVH = intraventricular hemorrhage; LOVA = long-standing overt ventriculomegaly in adults; NPH = normal pressure hydrocephalus; VP = ventriculoperitoneal.
de RibaupierreSRillietBVernetORegliLVillemureJG: Third ventriculostomy vs ventriculoperitoneal shunt in pediatric obstructive hydrocephalus: results from a Swiss series and literature review. Childs Nerv Syst23:527–5332007
HayhurstCOsman-FarahJDasKMallucciCL: Initial management of hydrocephalus associated with Chiari 1–syringomyelia complex by endoscopic third ventriculostomy: an outcome analysis. J Neurosurg108:1211–12142008
MohantyASumanRShankarSRSatishSPraharajSS: Endoscopic third ventriculostomy in the management of Chiari I malformation and syringomyelia associated with hydrocephalus. Clin Neurol Neurosurg108:87–922005
O'BrienDFHayhurstCPizerBMallucciCL: Outcomes in patients undergoing single-trajectory endoscopic third ventriculostomy and endoscopic biopsy for midline tumors presenting with obstructive hydrocephalus. J Neurosurg105:219–2262006
O'BrienDFJavadpourMCollinsDRSpennatoPMallucciCL: Endoscopic third ventriculostomy: an outcome analysis of primary cases and procedures performed after ventriculoperitoneal shunt malfunction. J Neurosurg103:393–4002005
Sainte-RoseCCinalliGRouxFEMaixnerRChumasPDMansourM: Management of hydrocephalus in pediatric patients with posterior fossa tumors: the role of endoscopic third ventriculostomy. J Neurosurg95:791–7972001
SmythMDTubbsRSWellonsJCIIIOakesWJBlountJPGrabbPA: Endoscopic third ventriculostomy for hydrocephalus secondary to central nervous system infection or intraventricular hemorrhage in children. Pediatr Neurosurg39:258–2632003