Endoscopic Third Ventriculostomy in Cases of Ventriculoperitoneal Shunt Malfunction: Does Shunt Duration Play a Role?

Abstract

Endoscopic third ventriculostomy (ETV) is now widely used to manage ventriculoperitoneal shunt (VPS) malfunctions, but outcome predictors are still debated. Different opinions exist about the prognostic factors, but shunt duration is generally considered unimportant although its influence remains poorly investigated. A total of 139 patients undergoing ETV for VPS malfunction were reviewed. Successful ETV was defined as shunt independence. There were 56 children and 83 adults; hydrocephalus had different causes. The mean VPS-ETV interval was 8.1 years. Ninety patients (64.7%) became shunt free. Children and adults achieved comparable success rates (64.3% and 65.1%, respectively). Age, gender, and cause of shunt malfunction were scarcely significant. The success rates were 86.8% (33/38 patients) in obstructive hydrocephalus (OH), 55.2% (36/67) in communicating hydrocephalus, and 58.8% (21/34) in myelomeningocele-related hydrocephalus, which was significant (P= 0.02). History of multiple revisions was a negative predictor (P<0.001): success rate, 39% (16/48) versus 81.3% (74/91). Any individual time step increase reduced the odds of ETV success by 34% (P= 0.014). In OH, the results were good regardless of any other factor, including shunt duration. In communicating hydrocephalus, short VPS-ETV intervals correlated with better outcome (P= 0.021), although they were irrelevant in perinatal posthemorrhagic hydrocephalus. In myelomeningocele-related hydrocephalus, shunt duration had intermediate effects. ETV is the first option for shunt malfunctions in OH and perinatal posthemorrhagic hydrocephalus, regardless of other factors. Conversely, in other types of hydrocephalus, the chances of shunt independence are lower and shunt duration and history of multiple shunt revisions are significant.