A retrospective analysis of revision endoscopic third ventriculostomy

Endoscopic third ventriculostomy (ETV) has gained favour as an effective treatment for obstructive hydrocephalus. However, the timing of ETV failure and the long-term efficacy of revision ETV remain poorly documented. A retrospective review was performed of patients undergoing revision ETV between 1999 and 2007. Only those patients in whom there was evidence of a good sustained clinical improvement after the initial ETV were considered candidates for ETV revision. All other patients underwent insertion of a ventriculoperitoneal shunt at the time of ETV failure. Failures that were selected for repeat ETV were subdivided into; early if the revision occurred within the first 3 months of the primary procedure and late if occurring after this. Ten patients underwent revision ETV (6% of all ETVs performed). Age ranged from 2 months to 32 years (mean 13.6 years). Three early revision ETV were performed at a mean of 1.3 months, and there were seven late revisions performed at a mean of 27 months. The stoma was closed in seven patients and narrowed in one patient, and a second membrane was found under the original patent stoma in a further two patients. In two patients, a third ETV procedure was performed (both at 1 month after second ETV), and the stoma was closed in both these patients. No patients have required a shunt. At last follow-up (mean 38 months), all patients remain well. Revision ETV appears a safe and effective means of managing hydrocephalus-providing there is clinical evidence that the primary procedure was initially effective. It is important to emphasise that patients with an initially successful ETV are by no means cured.