The role of endoscopic third ventriculostomy in the management of shunt malfunction.
OBJECTIVE
To evaluate the effectiveness of third ventriculostomy as an alternative to shunt revision in the management of shunt malfunction and infection in obstructive hydrocephalus.


METHODS
All of the clinical notes of 30 patients treated with third ventriculostomy for malfunctioning or infected shunts between January 1, 1974, and December 31, 1996, were retrospectively reviewed. Third ventriculostomy was performed under fluoroscopic control in the first seven patients and endoscopically in the remainder. A successful outcome was achieved if further shunt revision surgery was avoided. The median follow-up duration was 8.7 years


RESULTS
Twenty-three patients (76.7%) experienced successful outcomes, resulting in shunt independence. Of the seven failures, three were technical failures at the time of surgery and the remaining four were manifest within a median of 10 days, resulting in shunt revision. There have been no delayed failures.


CONCLUSIONS
Third ventriculostomy is a valuable alternative to shunt revision in patients affected by obstructive hydrocephalus presenting with shunt malfunction or infection. It should be considered in all suitable cases as the first-line treatment for obstructive hydrocephalus of all causes. Because all failures were manifest within a short time, it is likely that these successes will be durable.
Cinalli
G
G
Department of Pediatric Neurosurgery, Hôpital Necker-Enfants Malades, Université René Decartes, Paris, France.
Salazar
C
C
Mallucci
C
C
Yada
J Z
JZ
Zerah
M
M
Sainte-Rose
C
C
D000293:Adolescent; D000328:Adult; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D004660:Encephalitis / Q000453:epidemiology / Q000209:etiology; D004724:Endoscopy / Q000009:adverse effects; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006470:Hemorrhage / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D006849:Hydrocephalus / Q000453:epidemiology / Q000601:surgery*; D007223:Infant; D007427:Intracranial Pressure; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014696:Ventriculostomy / Q000009:adverse effects / Q000379:methods*