retrospective analysis of revision endoscopic third ventriculostomy

Purpose 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. Methods 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. Results 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. Conclusion 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”.