Endoscopic Third Ventriculostomy

Indications

• Patients with late-onset (adolescent or adult) nontumoral obstructive hydrocephalus have the highest rate of success after endoscopic third ventriculostomy (close to 90%). The high success rate in this group is likely related to the presence of intact pathways for cerebrospinal fluid (CSF) absorption.

• Patients with obstructive hydrocephalus resulting from other etiologies also have high success rates after this procedure. These etiologies include CSF pathway obstruction from tumors, cysts, infectious or hemorrhagic processes, and congenital obstructive hydrocephalus.

• Attempts to treat other forms of hydrocephalus with endoscopic third ventriculostomy have lower rates of success and are controversial. Regardless, successful outcomes have been reported after this procedure in patients with spinal dysraphism–associated hydrocephalus, slit ventricle syndrome, shunt infection or malfunction, normal-pressure hydrocephalus, encephalocele-associated hydrocephalus, and idiopathic hydrocephalus.