Endoscopic Third Ventriculostomy in Previously Shunted Children

Aim: Endoscopic third ventriculostomy (ETV) is a routine and safe procedure for treatment of obstructive hydrocephalus. The aim of our study was to evaluate EVS success rate in treating obstructive hydrocephalus in paediatric patients with former ventriculo-peritoneal (V-P) shunt implantation. Material and methods: We performed ETV in 36 patients with former V-P drainage implantation between 2001 and October 2011. Pre-surgical brain MRI performed in all patients confirmed an obstruction in aqueduct or outflow parts of the fourth ventricle. During the surgery, the V-P shunt was clipped and ETV was performed. In patients with favourable clinical condition and functional stoma on MR, the V-P shunt was removed 3 months after the ETV. In indicated patients, the Ommaya reservoir was inserted to enable emergency cerebrospinal fluid tapping. Results: Our group of 36 patients involved 11 patients with congenital aqueduct stenosis, 14 patients with posthemorrhagic hydrocephalus, 6 patients with post-infection hydrocephalus and 5 patients with Chiari malformation - associated hydrocephalus. Nine patients underwent unsuccessful ETV in infancy. Patients in whom V-P shunt could be removed three month after the ETV were evaluated as successful; 26 patients (72%) in our group were successful. There was one serious complication in the group - one patient died 2.5 years after the surgery due to delayed ETV failure. Conclusion: The ETV is a method of choice in obstructive hydrocephalus even in patients with former V-P shunt implantation. MR is feasible in acute or scheduled V-P shunt surgical revision. Hydrocephalus may be solved endoscopically in patients with confirmed obstruction in the ventricular system.