title: Endoscopic Third Ventriculostomy in 250 Adults With Hydrocephalus: Patient Selection, Outcomes, and Complications.
abstract: BACKGROUND
  Endoscopic third ventriculostomy (ETV) has been used predominantly in the pediatric population in the past. Application in the adult population has been less extensive, even in large neurosurgical centers. To our knowledge, this report is one of the largest adult ETV series reported and has the consistency of being performed at 1 center.
  
  
  OBJECTIVE
  To determine the efficacy, safety, and outcome of ETV in a large adult hydrocephalus patient series at a single neurosurgical center. In addition, to analyze patient selection criteria and clinical subgroups (including those with ventriculoperitoneal shunt [VPS] malfunction or obstruction and neurointensive care unit patients with extended ventricular drainage before ETV) to optimize surgical results in the future.
  
  
  METHODS
  We conducted a retrospective review of adult ETV procedures performed at our center between 2000 and 2014.
  
  
  RESULTS
  The overall rate of success (no further cerebrospinal fluid diversion procedure performed plus clinical improvement) of 243 completed ETVs was 72.8%. Following is the number of procedures with the success rate in parentheses: aqueduct stenosis, 56 (91%); communicating hydrocephalus including normal pressure hydrocephalus, nonnormal pressure hydrocephalus, and remote head trauma, 57 (43.8%); communicating hydrocephalus in postoperative posterior fossa tumor without residual tumor, 14 (85.7%); communicating hydrocephalus in subarachnoid hemorrhage without intraventricular hemorrhage, 23 (69.6%); obstruction from tumor/cyst, 42 (85.7%); VPS obstruction (diagnosis unknown), 23 (65.2%); intraventricular hemorrhage, 20 (90%); and miscellaneous (obstructive), 8 (50%). There were 9 complications in 250 intended procedures (3.6%); 5 (2%) were serious.
  
  
  CONCLUSIONS
  Use of ETV in adult hydrocephalus has broad application with a low complication rate and reasonably good efficacy in selected patients.
authors: *Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York;‡Department of Neurosurgery, Kaleida Health System, Buffalo, New York;§Department of Neurosurgery, Creighton University, Omaha, Nebraska (current affiliation).
authors: Walter
authors: W
authors: Grand
authors: Jody
authors: J
authors: Leonardo
authors: Andrea J
authors: AJ
authors: Chamczuk
authors: Adam J
authors: AJ
authors: Korus
mesh_terms: D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D044583:Neuroendoscopy / Q000009:adverse effects / Q000379:methods / Q000639:trends*; D018579:Patient Selection; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011859:Radiography; D012189:Retrospective Studies; D020542:Third Ventricle / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome; D014696:Ventriculostomy / Q000009:adverse effects / Q000379:methods / Q000639:trends*