Third Ventriculocisternostomy for Shunt Failure

Abstract

Background: Our objective was to analyze the relevance, potential prognostic factors, and complications of endoscopic third ventriculostomy (ETV) in patients with shunt failures.

Methods: Among 721 ETVs performed between 1999 and 2013, we studied 53 patients with shunts (31 men, 21 less than 18 years of age) who had an ETV performed for shunt failures as the result of various causes. We included all initial causes of hydrocephalus except adult chronic (i.e., "normal pressure") and pediatric communicant hydrocephalus. The mean duration between initial shunting for hydrocephalus and the ETV procedure was more than 11 years (137 months; range, 1 month to 34 years). Successful ETV procedure was defined as clinical improvement and shunt independence extending until the last follow-up visit.

Results: The success rate of the ETV procedure was 70% (37 of the 53 cases) with a mean follow-up of 51 months (from 3 to 157 months) and was not related to the age of the patient (P = 0.922), to the cause of hydrocephalus (P = 0.622), or to the number of shunt failures (P = 0.459). We also found no statistical difference (P = 0.343) between patients whose shunt had been in place for less than 5 years and those shunted more than 5 years. The presence of an infected shunt was not predictive of ETV failure (P = 0.395). No significant intraoperative or postoperative complications were noted.

Conclusion: This study confirms that ETV should be considered as the first therapeutic option before shunt revision in cases of initial obstructive hydrocephalus.

Keywords: Aqueductal stenosis; Endoscopic third ventriculostomy; Hydrocephalus; Shunt failure.