Postoperative Outcomes of Endoscopic Third Ventriculostomy in Pediatric Patients

Background Endoscopic third ventriculostomy is an established surgical treatment for pediatric hydrocephalus, particularly in obstructive cases. However, reported success rates vary widely, and the influence of patient age at the time of surgery remains controversial. Aims This study aimed to evaluate postoperative outcomes of endoscopic third ventriculostomy in children, with a particular focus on treatment failure over time and the impact of age at surgery. Methods A retrospective cohort study was conducted including all pediatric patients who underwent endoscopic third ventriculostomy between January 2017 and October 2023 at a single tertiary pediatric center. Demographic data, perinatal characteristics, operative details, and postoperative outcomes were collected from electronic medical records and analyzed pseudonymously. Endoscopic third ventriculostomy was considered successful if patency was maintained during follow-up or restored by revision; irreversible failure or subsequent shunt placement was defined as treatment failure. Survival analysis was performed using Kaplan–Meier curves, and groups were compared using log-rank testing. Results Twenty-eight patients were included, of whom 64.3% were male. Median age at surgery was 4.5 months, with 71.4% of patients operated on before one year of age. During follow-up, 17.9% of endoscopic third ventriculostomies remained patent. Primary treatment failure occurred in 25.0% of patients, while secondary failure was observed in 57.1%. Median time to failure of 50% of procedures was 91 days, and after 360 days, 25.0% of patients remained shunt-free. Patients operated on after the first year of life showed a tendency toward improved endoscopic third ventriculostomy survival compared with younger patients; however, this difference did not reach statistical significance (hazard ratio 0.88, p = 0.80). Conclusion Endoscopic third ventriculostomy represents an important treatment option for pediatric hydrocephalus but is associated with considerable failure rates during long-term follow-up. Patient age at surgery appears to influence postoperative outcomes, with a trend toward better results in older children. Careful patient selection is essential, and further prospective studies are needed to refine indications and optimize outcomes.