762 Age, Shunted Hydrocephalus, and Myelomeningocele as Factors Predicting Outcome with Endoscopic Third Ventriculostomy

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INTRODUCTION: Endoscopic third ventriculostomy (ETV) has been accepted as an effective treatment of obstructive hydrocephalus (OH) in selected patients. Age and presence of preexisting shunt have been debated as factors affecting ETV. We reviewed our series to determine factors affecting outcome, including those with myelomeningocele, with the aim of achieving greater success with ETV. METHODS: From 1998 to 2003, 68 patients with OH underwent ETV using a rigid endoscope with working channel and NMT balloon catheter. Retrospective review with mean follow-up of 2 years identified 47 patients with isolated aqueductal stenosis (AS), 9 with myelomeningocele, and 12 with space-occupying lesions of the third/ fourth ventricle. Success was defined as resolution of hydrocephalus without subsequent shunting after ETV. RESULTS: The overall success rate was 74%. In the AS group, there was 89% success in those >2 years old, but only 52% success in those <2 years old. In those with obstructive lesions of the third/fourth ventricle, there was 100% success in the nine patients >2 years old, whereas the three patients <2 years old failed. In the myelomeningocele group, 67% success was noted; five of the six successful myelomeningocele patients were >2 years old and had magnetic resonance imaging (MRI) cine evidence of AS and cerebrospinal fluid (CSF) outflow obstruction. Only two myelomeningocele patients did not have a preexisting shunt, and none of the failures had previous history of meningitis. CONCLUSION: Our results demonstrate high rates of failure in patients <2 years old with OH, which have been supported by other studies. No correlation between failure and the presence of a preexisting shunt was found in any group. The emerging acceptance of ETV for older patients with AS is validated by our results. Moreover, our success with older myelomeningocele patients indicates that MRI cine should be considered to assess for CSF outflow obstruction and potential benefit from ETV. Appropriate recognition of OH and successful ETV has significant impact in the overall treatment of myelomeningocele patients, many of whom have significant comorbidities.