title: Endoscopic re-opening of third ventriculostomy: Case series and review of literature.
abstract: OBJECTIVE
  Endoscopic third ventriculostomy (ETV) emerged as an effective alternative to shunting devices in patients with obstructive hydrocephalus. When ETV fails, neurosurgeons must choose between applying a shunting device or performing a repeat ETV (re-ETV) and attempt a shunt independent outcome. In this series, clinical, surgical and follow-up data from six patients who underwent a second ETV were reviewed.
  
  
  METHODS
  Between January 2005 and June 2015, six patients underwent re-ETV, with four being children. Causes of obstructive hydrocephalus included idiopathic aqueduct stenosis, congenital aqueduct stenosis, neonatal intraventricular haemorrage, hypothalamic glioma and post-meningitis aqueductal stenosis. Success of the procedure was defined by clinical improvement and shunt independence.
  
  
  RESULTS
  Overall success rate of this series was 83.3%, with re-ETV being effective in five of the six patients. The single case of re-ETV failure was observed in the pediatric population and was due to late stoma obstruction by tumoral growth, with a ventriculo-peritoneal shunt (VPS) being placed 6 months after re-ETV. In this series, no mortality and no major permanent morbidity were observed following re-ETV.
  
  
  CONCLUSIONS
  Repeat ETV is a safe and effective procedure and should be an option for treatment of recurrent obstructive hydrocephalus if stoma closure or obstruction is present. Younger age and the presence of a previous VPS should not discourage this procedure.
authors.affiliation: Faculty of Medicine, University of Porto, Porto, Portugal. Electronic address: moreira.ines5@gmail.com.
authors.forename: Inês
authors.initials: I
authors.lastname: Moreira
authors.affiliation: Faculty of Medicine, University of Porto, Porto, Portugal; Department of Neurosurgery, Centro Hospitalar de São João, Porto, Portugal; Neurosciences Unity, CUF Hospital, Porto, Portugal. Electronic address: josuepereira@sapo.pt.
authors.forename: Josué
authors.initials: J
authors.lastname: Pereira
authors.affiliation: Faculty of Medicine, University of Porto, Porto, Portugal; Department of Neurosurgery, Centro Hospitalar de São João, Porto, Portugal. Electronic address: jago79@gmail.com.
authors.forename: Joana
authors.initials: J
authors.lastname: Oliveira
authors.affiliation: Neurosurgical Department of Central Hospital of Maputo, Mozambique; Faculty of Health Sciences, University of Lúrio, Nampula, Mozambique. Electronic address: sfsalvador.neurocirurgia@gmail.com.
authors.forename: Sérgio F
authors.initials: SF
authors.lastname: Salvador
authors.affiliation: Faculty of Medicine, University of Porto, Porto, Portugal; Department of Neurosurgery, Centro Hospitalar de São João, Porto, Portugal; Neurosciences Unity, CUF Hospital, Porto, Portugal. Electronic address: ruimcvaz@gmail.com.
authors.forename: Rui
authors.initials: R
authors.lastname: Vaz
mesh_terms: D000368:Aged; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery*; D007231:Infant, Newborn; D008875:Middle Aged; D044583:Neuroendoscopy / Q000009:adverse effects / Q000379:methods*; D012086:Reoperation / Q000009:adverse effects / Q000379:methods*; D020542:Third Ventricle / Q000601:surgery*; D016896:Treatment Outcome; D014696:Ventriculostomy / Q000009:adverse effects / Q000379:methods*
keywords: Endoscopic third ventriculostomy; Hydrocephalus; Repeat endoscopic third ventriculostomy; Stoma closure