title: Third Ventriculocisternostomy for Shunt Failure.
abstract: BACKGROUND
  Our objective was to analyze the relevance, potential prognostic factors, and complications of endoscopic third ventriculostomy (ETV) in patients with shunt failures.
  
  
  METHODS
  Among 721 ETVs performed between 1999 and 2013, we studied 53 patients with shunts (31 men, 21 less than 18 years of age) who had an ETV performed for shunt failures as the result of various causes. We included all initial causes of hydrocephalus except adult chronic (i.e., "normal pressure") and pediatric communicant hydrocephalus. The mean duration between initial shunting for hydrocephalus and the ETV procedure was more than 11 years (137 months; range, 1 month to 34 years). Successful ETV procedure was defined as clinical improvement and shunt independence extending until the last follow-up visit.
  
  
  RESULTS
  The success rate of the ETV procedure was 70% (37 of the 53 cases) with a mean follow-up of 51 months (from 3 to 157 months) and was not related to the age of the patient (P = 0.922), to the cause of hydrocephalus (P = 0.622), or to the number of shunt failures (P = 0.459). We also found no statistical difference (P = 0.343) between patients whose shunt had been in place for less than 5 years and those shunted more than 5 years. The presence of an infected shunt was not predictive of ETV failure (P = 0.395). No significant intraoperative or postoperative complications were noted.
  
  
  CONCLUSIONS
  This study confirms that ETV should be considered as the first therapeutic option before shunt revision in cases of initial obstructive hydrocephalus.
authors.affiliation: Pôle Neuroscience (neurochirurgie), Centre hospitalo-universitaire de Toulouse, Université Paul-Sabatier, Toulouse, France.
authors.forename: Virakpagna
authors.initials: V
authors.lastname: Chhun
authors.affiliation: Pôle Neuroscience (neurochirurgie), Centre hospitalo-universitaire de Toulouse, Université Paul-Sabatier, Toulouse, France.
authors.forename: Oumar
authors.initials: O
authors.lastname: Sacko
authors.affiliation: Pôle Neuroscience (neurochirurgie), Centre hospitalo-universitaire de Toulouse, Université Paul-Sabatier, Toulouse, France.
authors.forename: Sergio
authors.initials: S
authors.lastname: Boetto
authors.affiliation: Pôle Neuroscience (neurochirurgie), Centre hospitalo-universitaire de Toulouse, Université Paul-Sabatier, Toulouse, France. Electronic address: franck_emmanuel.roux@yahoo.fr.
authors.forename: Franck-Emmanuel
authors.initials: FE
authors.lastname: Roux
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002557:Cerebrospinal Fluid Shunts; D002648:Child; D002675:Child, Preschool; D004724:Endoscopy / Q000379:methods; D004868:Equipment Failure; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery; D007223:Infant; D007431:Intraoperative Complications / Q000453:epidemiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D011379:Prognosis; D012086:Reoperation; D020542:Third Ventricle / Q000601:surgery*; D016896:Treatment Outcome; D014696:Ventriculostomy / Q000379:methods*; D055815:Young Adult
keywords: Aqueductal stenosis; Endoscopic third ventriculostomy; Hydrocephalus; Shunt failure