title: Long-term results of endoscopic third ventriculostomy: an outcome analysis.
abstract: OBJECTIVE
  Endoscopic third ventriculostomy (ETV) is the procedure of choice in the treatment of obstructive hydrocephalus. The excellent clinical and radiological success rates are well known. Nevertheless, very few papers have addressed the very long term outcomes of the procedure in very large series. The authors present a large case series of 113 patients who underwent 126 ETVs, and they highlight the initial postoperative outcome after 3 months and long-term follow-up with an average of 7 years.
  
  
  METHODS
  All patients who underwent ETV at the Department of Neurosurgery, Mainz University Hospital, between 1993 and 1999 were evaluated. Obstructive hydrocephalus was the causative pathology in all cases.
  
  
  RESULTS
  The initial clinical success rate was 82% and decreased slightly to 78% during long-term follow-up. Long-term success was analyzed using Kaplan-Meier curves. Overall, ETV failed in 31 patients. These patients underwent a second ETV or shunt treatment. A positive impact on long-term success was seen for age older than 6 months, and for obstruction due to cysts or benign aqueductal stenosis. The complication rate was 9% with 5 intraoperative and 5 postoperative events.
  
  
  CONCLUSIONS
  The high clinical success rate in short-term and long-term follow-up confirms ETV's status as the gold standard for the treatment of obstructive hydrocephalus, especially for distinct pathologies. The patient's age and underlying pathology may influence the outcome. These factors should be considered carefully preoperatively by the surgeon.
authors.affiliation: Neurosurgical Department, Universitaet des Saarlandes, Homburg/Saar, Germany;
authors.forename: Sonja
authors.initials: S
authors.lastname: Vulcu
authors.affiliation: Neurosurgical Department, Universitaet des Saarlandes, Homburg/Saar, Germany;
authors.forename: Leonie
authors.initials: L
authors.lastname: Eickele
authors.affiliation: Santobono-Pausilipon, Children's Hospital, Naples, Italy; and.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cinalli
authors.affiliation: Neurosurgical Department, Universitaetsmedizin Mainz, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Wagner
authors.affiliation: Neurosurgical Department, Universitaet des Saarlandes, Homburg/Saar, Germany;
authors.forename: Joachim
authors.initials: J
authors.lastname: Oertel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D044583:Neuroendoscopy; D012189:Retrospective Studies; D020542:Third Ventricle / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014696:Ventriculostomy; D055815:Young Adult
keywords: ETV = endoscopic third ventriculostomy; brain; endoscopic third ventriculostomy; hydrocephalus; long-term results; neuroendoscopy