Endoscopic Third Ventriculostomy for Obstructive Hydrocephalus in Children; Challenges and Clinical Outcomes

Abstract

Background: Endoscopic third ventriculostomy (ETV) has been established as a viable treatment option for obstructive hydrocephalus of children over 8 weeks of age. ETV in pediatric groups may be unsuccessful due to the failure of redirection of cerebrospinal fluid (CSF) flow, re-closure of ventriculostomy opening or due to infection. The exact cause is still debatable. Some issues like failure to eliminate the second membrane during the procedure or formation of the new arachnoid membrane at the stoma are still not clear. This study aims to assess the surgical failure of ETV and its predisposing factors.Methods: Thirty-two pediatric patients with hydrocephalus were analyzed retrospectively to assess efficacy of endoscopic third ventriculostomy in children. The patients’ age limit was between 6 months and 12 years. This is a retrospective study of 32 patients in Fayoum University Hospital in the period between May 2017 and December 2020. Patients having hydrocephalus in pediatric groups more than 8 weeks of age were included in the study.Results: The mean age of all patients was 24 months and the mean follow-up period was six months. Of 32 ETVs, the success rate was 78% in 25 patients and the failure rate was 22% in 7 patients. The study included 24 males (75 %) and 8 females (25%) with a male to female ratio (3:1). Clinical presentations varied from enlarged head (macrocrania), dilated scalp veins, repeated vomiting and poor ocular fixation and following. Complications were divided into failure of procedure, infection, CSF leak and re-exploration.Conclusions: Endoscopic ventriculocisternostomy remains an effective surgical technique in the treatment of obstructive hydrocephalus. It is linked to a very low rate of permanent morbidity and avoids ventriculo- peritoneal shunt-related morbidity and long life shunt dependence. But we should take in consideration good selection of indicated cases especially in pediatric groub.