Surgical Outcome of Endoscopic Third Ventriculostomy in Patients Having High ETV Success Score: One-Year Experience at a Tertiary Care Hospital


  • Muhammad Nawaz Khan Department of Neurosurgery, Lady Reading Hospital, Peshawar, Pakistan
  • Farooq Azam Department of Neurosurgery, Lady Reading Hospital, Peshawar, Pakistan
  • Muhammad Shaheer Akhtar
  • Waheed Alam Department of Neurosurgery, Lady Reading Hospital, Peshawar, Pakistan



Background & Objective:  Endoscopic third Ventriculostomy (ETV) is an accepted alternative to VP shunt in patients with obstructive hydrocephalus. We will share our experience and outcome.

Materials & Methods:  Thirty consecutive ETV cases performed by a single surgeon during 1 year in patients with an ETV success score of 60 or higher were included in this study. Patients’ demographics, outcomes, and complications are reported.

Results:  (60%) were male and 12 (40%) were female. The mean age in our study was 6.1 years ± 9 (mean ± SD). Posterior fossa tumor was the most common etiology in our series (46.6%) followed by aqueductal stenosis (23.3%). Eighty percent of our patients did not experience an ETV failure. The complication rate was 20%. Inadequate ventriculostomy in 6.6% of the patients was the commonest complication.

Conclusion:  ETV is safe and effective in patients with high ETV success scores.


Rekate HL. The definition and classification of hydrocephalus: a personal recommendation to stimulate debate. Cerebrospinal Fluid Res. 2008; 5: 2.

Gili JA, López-Camelo JS, Nembhard WN, Bakker M, de Walle HEK, Stallings EB, et al. Analysis of early neonatal case fatality rate among newborns with congenital hydrocephalus, a 2000-2014 multi-country registry-based study. Birth Defects Res. 2022; 114 (12): 631-44.

Kahle KT, Kulkarni AV, Limbrick DD, Jr., Warf BC. Hydrocephalus in children. Lancet (London, England), 2016; 387 (10020): 788-99.

Beuriat PA, Puget S, Cinalli G, Blauwblomme T, Beccaria K, Zerah M, et al. Hydrocephalus treatment in children: long-term outcome in 975 consecutive patients. J Neurosurg Pediatr. 2017; 20 (1): 10-8.

Kameda M. Therapeutic Tactics for Pediatric Hydrocephalus. No Shinkei Geka. 2022; 50 (2): 376-86.

Yadav YR, Parihar V, Pande S, Namdev H, Agarwal M. Endoscopic third ventriculostomy. J Neurosci Rural Pract. 2012; 3 (2): 163-73.

Moorthy RK, Rajshekhar V. Endoscopic third ventriculostomy for hydrocephalus: a review of indications, outcomes, and complications. Neurol India, 2011; 59 (6): 848-54.

Yadav YR, Bajaj J, Ratre S, Yadav N, Parihar V, Swamy N, et al. Endoscopic Third Ventriculostomy- A Review. Neurol India, 2021; 69 (Supplement): S502-s13.

Kulkarni AV, Drake JM, Kestle JR, Mallucci CL, Sgouros S, Constantini S. Predicting who will benefit from endoscopic third ventriculostomy compared with shunt insertion in childhood hydrocephalus using the ETV Success Score. J Neurosurg Pediatr. 2010; 6 (4): 310-5.

Gianaris TJ, Nazar R, Middlebrook E, Gonda DD, Jea A, Fulkerson DH. Failure of ETV in patients with the highest ETV success scores. J Neurosurg Pediatr. 2017; 20 (3): 225-31.

Labidi M, Lavoie P, Lapointe G, Obaid S, Weil AG, Bojanowski MW, et al. Predicting success of endoscopic third ventriculostomy: validation of the ETV Success Score in a mixed population of adult and pediatric patients. J Neurosurg. 2015; 123 (6): 1447-55.

Deopujari CE, Karmarkar VS, Shaikh ST. Endoscopic Third Ventriculostomy: Success and Failure. J Korean Neurosurg Soc. 2017; 60 (3): 306-14.

Rahman MM, Salam MA, Uddin K, Rahman MM, Islam MR, Haque MA, et al. Early Surgical Outcome of Endoscopic Third Ventriculostomy in the Management of Obstructive Hydrocephalus: A Randomized Control Trial. Asian J Neurosurg. 2018; 13 (4): 1001-4.

Lima B, Pratesi R. Endoscopic third ventriculostomy has no higher costs than ventriculoperitoneal shunt. Arquivos de neuro-psiquiatria. 2014; 72: 524-7.

Morgan E, Bankole OB, Mofikoya BO, Kanu OO, Ojo OA, Jeje EA, et al. Endoscopic third ventriculostomy success score in predicting short-term outcome in 68 children with hydrocephalus in a resource-limited tertiary centre in sub-Saharan Africa. Egyptian Journal of Neurosurgery, 2019; 34 (1): 31.

Khan B, Hamayun S, Haqqani U, Khanzada K, Ullah S, Khattak R, et al. Early Complications of Ventriculoperitoneal Shunt in Pediatric Patients With Hydrocephalus. Cureus, 2021; 13 (2): e13506.

El Damaty A, Marx S, Cohrs G, Vollmer M, Eltanahy A, El Refaee E, et al. ETV in infancy and childhood below 2 years of age for treatment of hydrocephalus. Child's Nervous System, 2020; 36 (11): 2725-31.

Pranata R, Yonas E, Vania R, Rachmadian CV, July J. Preoperative Third Ventricle Floor Bowing is Associated with Increased Surgical Success Rate in Patients Undergoing Endoscopic Third Ventriculostomy – A Systematic Review and Meta-analysis. Neurol India, 2022; 70 (2): 664-9.

Jung TY, Chong S, Kim IY, Lee JY, Phi JH, Kim SK,

et al. Prevention of Complications in Endoscopic Third Ventriculostomy. J Korean Neurosurg Soc. 2017; 60 (3): 282-8.






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