title: The role of endoscopic third ventriculostomy in the treatment of hydrocephalus.
abstract: OBJECTIVE
  Hydrocephalus remains a major public health problem. Conventional treatment has relied on extracranial shunting of CSF to another systemic site, but this approach is associated with a high rate of complications. Endoscopic third ventriculostomy (ETV) is a novel treatment for select forms of hydrocephalus that can eliminate the need for implantation of a lifelong ventricular shunt system. However, the indications for ETV are contested and its long-term effectiveness is not well established.
  
  
  METHODS
  The authors selected 100 consecutive patients who underwent ETV for hydrocephalus beginning in 1994. Patients were enrolled and treated at a single institution by a single surgeon. The primary outcome was success of ETV, with success defined as no need for subsequent surgery for hydrocephalus.
  
  
  RESULTS
  Ninety-five patients satisfied the inclusion criteria. The mean follow-up period was 5.1 years (median 4.7 years) with follow-up data available for as long as 17 years. Patients commonly presented with headache (85%), ataxia (34%), emesis (29%), and changes in vision (27%). The success rate for ETV was 75%. Twenty-one patients (22%) in the series had malfunctioning shunts preoperatively and 13 (62%) were successfully treated with ETV. Preoperative inferior bowing of the third ventricle floor on MRI was significantly associated with ETV success (p < 0.05).
  
  
  CONCLUSIONS
  Endoscopic third ventriculostomy is an effective and durable treatment for select patients with hydrocephalus. When successful, the procedure eliminates the lifelong complications associated with implanted ventricular shunts.
authors.affiliation: Department of Neurosurgery, Boston Children's Hospital, Boston, Massachusetts 02115, USA.
authors.forename: Timothy W
authors.initials: TW
authors.lastname: Vogel
authors.forename: Biji
authors.initials: B
authors.lastname: Bahuleyan
authors.forename: Shenandoah
authors.initials: S
authors.lastname: Robinson
authors.forename: Alan R
authors.initials: AR
authors.lastname: Cohen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001900:Boston; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery*; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D044583:Neuroendoscopy / Q000592:standards / Q000706:statistics & numerical data / Q000639:trends; D018579:Patient Selection; D012189:Retrospective Studies; D020542:Third Ventricle / Q000601:surgery*; D016896:Treatment Outcome; D014696:Ventriculostomy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods