Background: Most of the present literature comparing endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunt (VPS) are retrospective analysis or prospective case studies which carry a low level of evidence. Our study is a randomized controlled trial (RCT) which provides higher level of evidence required to answer the debate as to which is a better modality of treatment in obstructive hydrocephalus comparing the efficacy, clinical profile, and failure of these two interventions. Methods: This experimental RCT was conducted at in the department of neurosurgery. We enrolled patients with symptomatic obstructive hydrocephalus based on inclusion and exclusion criteria. Patients were randomized into ETV and VPS groups from December 2022 to January 2024, with a minimum follow-up of 6 months until June 2024. Outcomes were compared preoperatively and postoperatively using the Statistical Package for the Social Sciences 22.0 for statistical analysis. Results: Forty-four patients participated, with 22 in each group. Hydrocephalus due to tumors was observed in 70.4% of patients, 43.2% of whom had posterior fossa tumors. Clinical symptom resolution occurred in 90.9% of the ETV group and 100% of the VPS group ( P = 0.14). The mean Evan’s index (EI) difference was statistically significant, favoring VPS ( P = 0.006). Association of failure was with different variables included age below 6 months ( P = 0.013), non-resolution of symptoms ( P = 0.02), moderate ETV success scores (50–70) ( P = 0.005), EI >0.4 ( P = 0.02), and absence of cerebrospinal fluid flow ( P = 0.001). Overall, success rates for ETV and VPS were 77.3% and 90.9%, respectively ( P = 0.38). Survival analysis showed mean estimate of 20.34 ± 1.54 months for ETV group and 23.45 ± 0.73 months for VPS group with P = 0.317. Conclusion: There was a lower failure rate in the VPS group but VPS had more complications compared to ETV. As an RCT, this study provides a higher level of evidence and gives relevance to these results.
Jain et al. (2025) studied this question.