Long-Term Success of Endoscopic Third Ventriculostomy in the Pediatric Population with Aqueductal Stenosis

Abstract

To evaluate the long-term success rate of endoscopic third ventriculostomy (ETV) in the treatment of hydrocephalus due to aqueductal stenosis in the pediatric population. Between January 2007 and June 2023, a total of 82 children underwent ETV surgery for hydrocephalus and met the inclusion criteria for our study. The children's medical records were reviewed, and cases requiring additional surgery in the months and years following surgery for ventriculostomy failure were reviewed. The mean age was 5.35years. Successful ETV was observed in 74 children with a successful ETV rate of 90%. The median follow-up was 6.75years (2 months to 15.5years). Eight children (10%) underwent additional surgery. In 7 cases, additional surgery was performed within 3months, while in the remaining case; a delayed failure was noted (more than 3years later). At 6months and 3years, the cumulative proportion of children with revision-free survival was 91%, declining slightly to 89% at 5years. ETV is highly effective in treating hydrocephalus in pediatric patients with aqueductal stenosis, with a 91% success rate at 6months and 3years. Although the success rate drops slightly to 89% at 5years, it still demonstrates durability. Late failures are usually characterized by symptoms of increased intracranial pressure. While patients with a confirmed successful ETV at 6months may be considered for reduced follow-up frequency, it is critical to educate them about the symptoms of intracranial hypertension and the importance of seeking medical attention promptly if such symptoms occur.