The role of endoscopic third ventriculostomy in the treatment of communicating hydrocephalus

Objective: To elucidate the role of endoscopic third ventriculostomy (ETV) in patients with secondary and idiopathic communicating hydrocephalus (HCP). Methods: A series of 36 patients with communicating HCP (21 men and 15 women) were treated by ETV between November 2007 and February 2010. The patients age ranged from 19 to 81 years old (mean 52 years), and had a follow-up of 6 to 36 months (mean 9.2 months). The patients were divided into a group of 29 patients with secondary communicating HCP and a group of 7 patients with normal pressure HCP. Sixteen (44.4%) of the patients had a previous ventriculoperitoneal shunt placement that presented with shunt malfunction. Results: The etiology of secondary HCP was subarachnoid hemorrhage, meningitis, trauma, neoplasm, and others. Etiology was not possible to determine in some patients. The outcome of ETV was considered successful in 27/36 patients (75%). A Kaplan-Meier analysis revealed that the successful proportion of ETVs in secondary communicating HCP at 0.5, 1, and 3 months of follow-up was 0.83, 0.8, and 0.77, respectively; in the idiopathic normal pressure HCP group it was 0.83 initially and became stable at 0.66 after the first month. Overall, the successful proportion of ETV in communicating HCP was at 0, 0.5, 1, and 3 months of follow-up was 0.97, 0.83, 0.78, and 0.75. Conclusions: ETV is a good option in the management of secondary communicating HCP, normal pressure HCP, and replacing malfunctioning ventriculoperitoneal shunts. The indications of ETV as a first-line treatment in communicating HCP needs further study; however, results are promising.