Outcome of Endoscopic Third Ventriculostomy: An Experience of 80 Treated Patients

  • MUMTAZ ALI Prime Teaching Hospital and 2Irfan General Hospital, Peshawar
  • AKRAM ULLAH Prime Teaching Hospital and 2Irfan General Hospital, Peshawar
  • SAJID KHAN Prime Teaching Hospital and 2Irfan General Hospital, Peshawar
  • ZUBAIR BASHIR Prime Teaching Hospital and 2Irfan General Hospital, Peshawar
  • RAMZAN HUSSAIN Prime Teaching Hospital and 2Irfan General Hospital, Peshawar
Keywords: ETV (Endoscopic Third Ventriculostomy), communicating hydrocephalus, Posterior fossa tumors, Aqueductal stenosis


Objective: To examine the outcome of Endoscopic Third Ventriculostomy in 80 consecutive patients operated in Irfan General Hospital and Prime Teaching Hospital Peshawar.
Materials and Methods: Prospective observational study was conducted in the neurosurgery department of Prime Teaching Hospital and Irfan General Hospital Peshawar. 80 patients (48 male and 32 female) were followed for 3 months. The inclusion criteria all patients with Third ventricular hydrocephalus were included in this study and the exclusion criteria unwilling patients and those who opted for VP shunting rather than ETV. Data was analyzed using SPSS version 22.
Results: ETV was performed in 80 patients. With highest success rate inAqueductal stenosis and posterior fossa tumors 88% and 87% respectively. ETV had a lowest success score of 50% in patients with Hydrocephalus TBM. Common post-operative complications were seizures and CSF leakage.
Conclusion: ETV is less invasive and effective treatment for non-communicating hydrocephalus.ETV is most effective in treating aqueductal stenosis and posterior fossa tumors. The overall success rate of ETV is 74%. Based on these findings, it is recommended that ETV should be attempted as first line treatment for patients with triventricular hydrocephalus due to various pathologies.


1. Aranha A, Choudhary A, Bhaskar S, Gupta L. A randomized study comparing endoscopic third ventriculostomy versus ventriculoperitoneal shunt in the management of hydrocephalus due to tuberculous meningitis. Asian journal of neurosurgery, 2018; 13 (4): 1140.
2. Kahle KT, Kulkarni AV, LimbrickJr DD, Warf BC. Hydrocephalus in children. The Lancet. 2016; 387 (10020): 788-99.
3. Warf BC, Collaboration EANR. Pediatric hydrocephalus in East Africa: prevalence, causes, treatments, and strategies for the future. World neurosurgery, 2010; 73 (4): 296-300.
Kirkpatrick M, Engleman H, Minns R. Symptoms and signs of progressive hydrocephalus. Archives of disease in childhood, 1989; 64 (1): 124-8.
5. Dinçer A, Özek MM. Radiologic evaluation of pediatric hydrocephalus. Child's Nervous System, 2011; 27 (10): 1543.
6. Hopf NJ, Grunert P, Fries G, Resch KD, Perneczky A. Endoscopic third ventriculostomy: outcome analysis of 100 consecutive procedures. Neurosurgery, 1999; 44 (4): 795-804.
7. Drake JM. Endoscopic third ventriculostomy in pediatric patients: the Canadian experience. Neurosurgery, 2007; 60 (5): 881-6.
8. Gianaris TJ, Nazar R, Middlebrook E, Gonda DD, Jea A, Fulkerson DH. Failure of ETV in patients with the highest ETV success scores. Journal of Neurosurgery: Pediatrics, 2017; 20 (3): 225-31.
9. Warf BC, Mugamba J, Kulkarni AV. Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus in Uganda: report of a scoring system that predicts success. Journal of Neurosurgery: Pediatrics, 2010; 5 (2): 143-8.
10. Kulkarni AV, Riva-Cambrin J, Browd SR. Use of the ETV Success Score to explain the variation in reported endoscopic third ventriculostomy success rates among published case series of childhood hydrocephalus. Journal of Neurosurgery: Pediatrics, 2011; 7 (2): 143-6.
11. Jones R, Stening W, Brydon M. Endoscopic third ventriculostomy. Neurosurgery, 1990; 26 (1): 86-92.
12. Schroeder HW, Niendorf W-R, Gaab MR. Complications of endoscopic third ventriculostomy. Journal of neurosurgery, 2002; 96 (6): 1032-40.
13. Jung T-Y, Chong S, Kim I-Y, Lee JY, Phi JH, Kim S-K, et al. Prevention of complications in endoscopic third ventriculostomy. Journal of Korean Neurosurgical Society, 2017; 60 (3): 282.
14. Wright Z, Larrew TW, Eskandari R. Pediatric Hydrocephalus: Current State of Diagnosis and Treatment. Pediatrics in review, 2016; 37 (11): 478-90.
15. Fritsch MJ, Kienke S, Ankermann T, Padoin M, Mehdorn HM. Endoscopic third ventriculostomy in infants. Journal of Neurosurgery: Pediatrics, 2005; 103 (1): 50-3.
16. Sacko O, Boetto S, Lauwers-Cances V, Dupuy M, Roux F-E. Endoscopic third ventriculostomy: outcome analysis in 368 procedures. Journal of Neurosurgery: Pediatrics, 2010; 5 (1): 68-74.
17. Scarrow AM, Levy EI, Pascucci L, Albright AL. Outcome analysis of endoscopic III ventriculostomy. Child's Nervous System, 2000; 16 (7): 442-4.
18. Amini A, Schmidt RH. Endoscopic third ventriculostomy in adult patients. Neurosurgical focus, 2005; 19 (6): 1-6.
Original Article