Secondary Endoscopic Third Ventriculostomy for Shunt Malfunction

Background: The efficacy of endoscopic third ventriculostomy (ETV) following cerebrospinal fluid shunting procedures has been disputed and claimed as having a less favorable outcome. Objective: The aim of this study is to evaluate the success of ETV in the treatment of obstructive hydrocephalus in patients primarily treated by ventriculoperitonael shunt (VPS). Patients and Methods: A retrospective analysis of the medical records of fifteen patients managed by secondary ETV for obstructive hydrocephalus after VPS malfunction was performed. Patients younger than 1 year of age and those with communicating hydrocephalus were excluded. In case of favorable clinical outcome, Computed tomography (CT) brain and Magnetic Resonance Imaging (MRI) proved functioning stoma, the VPS was initially ligated or removed 3 months after ETV. the patients clinical data were analyzed in relation to outcome. Results: The mean age of the patients was 5.6 ± 4.8 years (range 2 – 18 years). ETV was successful in ten patients (66.6%). No major morbidity or mortality was recorded; only four patients had a minor morbidity. Shunt revision was done in five patients, within the first month. We had no delayed ETV failure for an average twelve months follow up period. None of the contributing factors were statistically correlated to the outcome in our series. Conclusion: Secondary ETV is a safe and effective technique in the management of patients with non-communicating hydrocephalus with malfunctioning shunts. Failures manifest early in the first month, though long-term follow up is mandatory.