Surgical outcome of endoscopic third ventriculostomy compared to ventriculoperitoneal shunt in non-communicating or obstructive hydrocephalus

Abstract

Objectives: To assess and compare the effectiveness of Endoscopic Third Ventriculostomy over Ventriculoperitoneal shunt in terms of rate of revision in non-communicating or obstructive hydrocephalus at a tertiary care centre in a low-middle-income country. Materials and methods: A Prospective Cohort Study was conducted from January 2019 to December 2020 at PIMS/SZABMU, Islamabad, Pakistan. A total of 104 patients of either gender under the age of 12 years diagnosed with non-communicating/obstructive hydrocephalus were enrolled in this study. They were allocated into two equal groups of 52 by the lottery method. One group underwent Ventriculoperitoneal Shunt (Group I) and another group underwent Endoscopic Third Ventriculostomy (Group II). They received routine treatment of one-week postoperative prophylactic broad-spectrum antibiotics. They were discharged on the third postoperative day and were instructed for follow-up on the 4th, 12th and 24th postoperative week. Clinically, successful outcomes were defined as no event occurring during or after the surgery that could result in reoperation or any significant postoperative complication. Results: There were 55.8% males and 44.2% females in group I while 50.0% males and 50.0% females were in group II. The mean age of Group I was 0.89 years ± 1.5 SD while 2.3 years ± 2.8 SD in group II. During the procedure, the overall complication rate was 0% in group I and 4.1% in group II. In the 4th postoperative week, the overall complication rate was 5.9% in group I and 4.1% in group II. At the 12th postoperative week, the overall complication rate was 17.6% in group I and 2.0% in group II. On the 24th postoperative week, the overall complication rate was 9.8% in group I and none in group II. During the procedure, reoperation was needed in 0% in group I and 4.1% in group II. In the 4th postoperative week, reoperation was needed in 5.9% of patients in group I and 2.0% in group II. In the 12th postoperative week, reoperation was needed in 17.6% of patients in group I and 2.0% in group II. At the 24th postoperative week, reoperation was needed in 9.8% of patients in group I and none in group II. The overall mortality rate was 5.9% in group I and 4.1% in group II. Conclusion: Endoscopic Third Ventriculostomy procedure was found to be better than the Ventriculoperitoneal shunt in terms of reoperation and complication rate at the 4th, 12th and 24th week after the procedure in infants and children with non-communicating/obstructive hydrocephalus.