title: A retrospective analysis of revision endoscopic third ventriculostomy.
abstract: OBJECTIVE
  Endoscopic third ventriculostomy (ETV) has gained favour as an effective treatment for obstructive hydrocephalus. However, the timing of ETV failure and the long-term efficacy of revision ETV remain poorly documented.
  
  
  METHODS
  A retrospective review was performed of patients undergoing revision ETV between 1999 and 2007. Only those patients in whom there was evidence of a good sustained clinical improvement after the initial ETV were considered candidates for ETV revision. All other patients underwent insertion of a ventriculoperitoneal shunt at the time of ETV failure. Failures that were selected for repeat ETV were subdivided into; "early" if the revision occurred within the first 3 months of the primary procedure and "late" if occurring after this.
  
  
  RESULTS
  Ten patients underwent revision ETV (6% of all ETVs performed). Age ranged from 2 months to 32 years (mean 13.6 years). Three "early" revision ETV were performed at a mean of 1.3 months, and there were seven "late" revisions performed at a mean of 27 months. The stoma was closed in seven patients and narrowed in one patient, and a second membrane was found under the original patent stoma in a further two patients. In two patients, a third ETV procedure was performed (both at 1 month after second ETV), and the stoma was closed in both these patients. No patients have required a shunt.
  
  
  CONCLUSIONS
  At last follow-up (mean 38 months), all patients remain well. Revision ETV appears a safe and effective means of managing hydrocephalus-providing there is clinical evidence that the primary procedure was initially effective. It is important to emphasise that patients with an initially successful ETV are by no means "cured".
authors.affiliation: Department of Neurosurgery, The General Infirmary at Leeds, Great George Street, Leeds, West Yorkshire, LS1 3EX, UK.
authors.forename: Surash
authors.initials: S
authors.lastname: Surash
authors.forename: Paul
authors.initials: P
authors.lastname: Chumas
authors.forename: Deepti
authors.initials: D
authors.lastname: Bhargava
authors.forename: Darach
authors.initials: D
authors.lastname: Crimmins
authors.forename: John
authors.initials: J
authors.lastname: Straiton
authors.forename: Atul
authors.initials: A
authors.lastname: Tyagi
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery*; D007223:Infant; D008297:Male; D044583:Neuroendoscopy; D012086:Reoperation; D012189:Retrospective Studies; D020542:Third Ventricle / Q000601:surgery*; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt; D014696:Ventriculostomy / Q000379:methods*; D055815:Young Adult