Patient selection in endoscopic third ventriculostomy

Endoscopic third ventriculostomy (ETV) has become a common procedure to manage hydrocephalus in select patients. However, there is still controversy regarding the indication of ETV as the primary procedure given its variable success rates. The purpose of this study is to review our institutional experience with ETV for a variety of patients. A total of 197 patients underwent endoscopic third ventriculostomy from July 1994 to June 2004. The medical records, operative reports, and imaging studies, when available, were retrospectively reviewed with regard to outcome, complications and patency rate. Treatment failure was defined as the need to shunt the patient within 4 weeks of performing the ETV. There were 104 males and 93 females with a mean age of 14.6 years (range 7 weeks to 80 years). The overall success rate was 72%. The mean follow-up was 24.6 months. Eight patients underwent 11 repeat ETVs at an average interval period of 24.9 months with a patency rate of 75% following the second procedure. Only two cases were aborted due to anatomical reasons. The highest success rates were achieved for obstructive hydrocephalus from midbrain/tectal tumor (92%, N=25), pineal tumor (90 %, N=10), and dandy-walker malformation (100%, N=3). Lower patency rates, 50% respectively, were obtained in patients with post-hemorrhagic (N=8) and post-infectious (N=2) hydrocephalus.