title: Long-Term Outcomes of Endoscopic Third Ventriculostomy in Adults.
abstract: OBJECTIVE
  To describe long-term outcomes of endoscopic third ventriculostomy (ETV) in adults with hydrocephalus.
  
  
  METHODS
  Single-institution retrospective review of adults treated with ETV between 1998 and 2006. Patient demographic, treatment, and follow-up data were collected. The patients were divided into 2 groups: primary ETV for patients with previously untreated or newly diagnosed hydrocephalus and secondary ETV for patients with a previous shunt presenting with shunt malfunction. ETV outcome was deemed successful if the patient remained shunt-free after ETV. Multivariate analysis was performed using Cox regression.
  
  
  RESULTS
  The study population comprised 190 patients, with a median age of 43 years (range, 16-79 years). The median duration of follow-up was 112 months (range, 1-190 months). The primary ETV group contained 129 patients; the secondary ETV group, 61 patients. Operative complications occurred in 11 patients (6%). A successful outcome was obtained in 139 patients (73%). ETV failure occurred in 51 patients, with a median time to failure of 2 months (range, 0-124 months). Although the majority (86%) of ETV failures occurred within 2 years postoperatively, failure was noted in 3 cases between 5 and 10 years after intervention, including in 1 patient at a 124-month follow-up. In multivariate analysis, only previous shunt was found to influence outcomes (P = 0.021), with shorter ETV survival noted in patients with a previous shunt. Age, indication, and ETV success did not influence outcome.
  
  
  CONCLUSIONS
  ETV is a safe procedure with excellent rates of long-term efficacy; however, late failure can occur, and patients should be instructed to seek medical advice if symptoms recur. A previous shunt is associated with a higher ETV failure rate.
authors.affiliation: Division of Neurosciences, Salford Royal NHS Foundation Trust, Manchester, UK; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK. Electronic address: mwaqar@doctors.org.uk.
authors.forename: Mueez
authors.initials: M
authors.lastname: Waqar
authors.affiliation: Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Ellenbogen
authors.affiliation: Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK.
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Stovell
authors.affiliation: Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK.
authors.forename: Rafid
authors.initials: R
authors.lastname: Al-Mahfoudh
authors.affiliation: Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK; Department of Neurosurgery, Alder Hey Children's Hospital, Liverpool, UK.
authors.forename: Conor
authors.initials: C
authors.lastname: Mallucci
authors.affiliation: Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK; Institute of Translational Medicine, The University of Liverpool, Liverpool, UK.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Jenkinson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D044583:Neuroendoscopy / Q000706:statistics & numerical data*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D020542:Third Ventricle / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology; D017287:Ventriculoperitoneal Shunt / Q000706:statistics & numerical data*; D014696:Ventriculostomy / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Endoscopic third ventriculostomy; Hydrocephalus; Long-term outcomes; Shunt