Introduction: Treatment of specific patterns of symptomatic hydrocephalus in the adult patient may be accomplished with endoscopic third ventriculostomy (ETV) as an alternative to insertion of a ventriculoperitoneal (VP) shunt or when VP shunt failure occurs. Treatment of hydrocephalus with a VP shunt, while effective, is associated with a significant shunt failure rate that results in VP shunt revision surgery. This review examines a single center experience with ETV to treat hydrocephalus in symptomatic adult patients.
Methods: Adult patients (=18 years) with a diagnosis of hydrocephalus who were treated with ETV in Calgary between January 1994 and July 2014 were reviewed using a clinic database and registry. All patients were treated by one neurosurgeon.
Results: 163 adult patients with symptomatic hydrocephalus treated with ETV were identified (male=92; female=71). Mean age at the time of ETV was 46.5 years (range 18-83.4 years). 118 underwent ETV as a primary treatment and 45 patients underwent treatment after presenting with VP shunt failure (secondary ETV). 113/163 patients had a diagnosis of aqueductal stenosis, 22/163 had a diagnosis of tumor. Mean followup was 8.2 years (range 0.3-18.4 years). Symptoms in 149/163 (91.4%) of ETV patients were better or unchanged at last followup. 104/118 (88.1%) of primary ETV patients were shunt free at last followup. 39/45 (86.7%) of secondary ETV patients were shunt free at last followup.
Conclusions: Endoscopic (ETV) treatment of hydrocephalus is an effective long-term treatment in a select population adult patients with hydrocephalus. Outcome/results are similar for patients where ETV is used as either a primary or secondary treatment. 87-88% of patients remain shunt free with a mean 8.2 years of followup.
Patient Care: ETV has a very significant and effective role in the treatment of select adult patients with hydrocephalus. The long-term results are excellent and this procedure has the potential to avoid many of the complications and issues associated with VP shunt surgery.
Learning Objectives: 1) To understand the role of ETV for primary treatment of hydrocephalus in the adult patient.
2) To understand the role of ETV for secondary treatment of hydrocephalus in the adult patient.