Value of endoscopic third ventriculostomy instead of shunt revision.

Background: The purpose of this study was to analyze the value of endoscopic third ventriculostomy (ETV) in patients with shunt malfunction or infection.

Methods: ETV was performed in 263 patients in Greifswald between 1993 and 2008. We reviewed the data of all patients with previous shunts who underwent ETV instead of shunt revision. The procedure was successful when subsequent shunt implantation was avoided.

Results: Neuroendoscopy was performed in 30/31 previously shunted patients. The average age of the patients was 26.4 years ranging from 6 months to 69 years (male/female ratio: 18/12). The primary cause of hydrocephalus was aqueductal stenosis in 11, myelomeningocele in 5, posthemorrhagic in 5, postmeningitic in 3, tumor-related obstruction in 2, supracerebellar arachnoid cyst in 2, posttraumatic in 1 and a complex congenital hydrocephalus in 1. ETV was successful in 18 patients (60%) with a mean follow-up period of 51 months. 12 patients (40%) did not benefit from ETV and required a permanent shunt. 11 of them received the shunt within 3 months after failed ETV. ETV failed in all children <2 years of age. A benefit of ETV without subsequent shunt procedures was recognized in 18/27 (66.7%) with an obstructive and 0/3 (0%) patients with a communicating cause of the hydrocephalus. Complications occurred in 2 patients (6.7%).

Conclusions: ETV is a potential treatment option when shunts fail in patients with obstructive hydrocephalus. If MR imaging shows no obstruction, a shunt revision is recommended. Patients with a posthemorrhagic and postmeningitic hydrocephalus are poor candidates for ETV.