Third Ventriculostomy for Treatment of Hydrocephalus: Results of 271 Procedures

The indication for endoscopic third ventriculostomy (ETV) includes almost any hydrocephalus. Depending on the underlying pathology, a highly variable outcome has been reported. Here, the authors present their experience with ETV in the treatment of hydrocephalus after application of this technique for 13 years. Between January 1993 and October 2005, 271 third ventriculostomies were undertaken. Indications included obstructive hydrocephalus caused by tumor, aqueductal stenosis, hemorrhage and brain infarction, and selected cases of communicating hydrocephalus. A standard endoscopic ventriculostomy was performed at the floor of the third ventricle, consisting of a blunt perforation and subsequent enlargement of the stomy with a balloon catheter. The mean age of the patients was 41 years with a range from 1 day up to 85 years. Overall, symptoms improved clinically in 69% and the ventricular size decreased in 64%. In 1 case, the procedure had to be abandoned. The success rate of the procedure depended highly on the underlying pathology (116 cases with obstructive hydrocephalus caused by tumor, 81% success rate; 56 cases with aqueductal stenosis, 73% success rate; 35 cases of intraventricular hemorrhage, 66% radiologic improvement; 15 cases with cerebellar infarction and fourth ventricular malformation each and a success rate of 86% and 53% respectively; 35% clinical improvement in 23 cases communicating hydrocephalus; 50% improvement in 4 cases associated with myelomeningocele). Complications included 2 deaths (0.7%) and 4 permanent deficits (1.5%). In all, ETV represents a safe and reliable procedure for hydrocephalus treatment. It is the procedure of choice for obstructive hydrocephalus.