Endoscopic third ventriculostomy: the Lebanese experience.
BACKGROUND
Endoscopic third ventriculostomy (ETV) has gained wide popularity as a first-line treatment for obstructive hydrocephalus (OHC). We have been performing ETV since 1998. We report our experience with this technique in the management of OHC.


METHODS
Between 1998 and 2007, we performed 49 ETV procedures in 46 patients suffering from OHC. Medical records were retrospectively reviewed. Success was defined as shunt-free survival.


RESULTS
There were 29 males and 17 females with a mean age of 23 years (6 months-65 years). Aqueductal stenosis and tectal tumor were the most common etiologies (63%). Seven patients (15.6%) had early ETV failure. Of 38 patients with initial success and available follow-up, shunt independence was achieved in 29 patients (76.3%) after a mean follow-up of 37 months. Kaplan-Meier analysis yielded a 70% 5-year shunt-free survival rate. On multivariate analysis, no variables could predict early or late ETV failure. Transient complications occurred in 6 patients (13%), but there were no ETV-related deaths or permanent morbidity.


CONCLUSIONS
ETV is a safe and effective treatment for OHC, resulting in a high rate of long-term shunt independence with a low risk of complications. ETV should be considered the treatment of choice for patients with OHC and its development as a substitute to shunt placement should be encouraged in neurosurgically developing countries.
Rahme
Ralph
R
Department of Neurosurgery, Saint-Joseph University and Hôtel-Dieu de France, Beirut, Lebanon.
Rahme
Rudy J
RJ
Hourani
Roula
R
Moussa
Ronald
R
Nohra
Georges
G
Okais
Nabil
N
Samaha
Elie
E
Rizk
Tony
T
D000293:Adolescent; D000328:Adult; D000368:Aged; D002528:Cerebellar Neoplasms / Q000401:mortality / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D004724:Endoscopy / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006849:Hydrocephalus / Q000401:mortality* / Q000601:surgery*; D007223:Infant; D053208:Kaplan-Meier Estimate; D007861:Lebanon / Q000453:epidemiology; D008297:Male; D008527:Medulloblastoma / Q000401:mortality / Q000601:surgery; D008875:Middle Aged; D009017:Morbidity; D010871:Pinealoma / Q000401:mortality / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D020542:Third Ventricle / Q000601:surgery*; D014696:Ventriculostomy / Q000379:methods* / Q000706:statistics & numerical data; D055815:Young Adult