T he technique of endoscopic third ventriculostomy (ETV) has been under close evaluation as a treatment option for obstructive hydrocephalus. Although early on the procedure was associated with a very high, unacceptable complication rate, 41 more recent publications have reported success rates of about 70% and low complication rates, including mortality, around 0.5%-1.0%. 9,13,20,31,35 Nowadays, ETV is accepted as the gold standard for treatment of obstructive hydrocephalus. In comparison with ventriculoperitoneal shunting, a significantly lower complication rate and reoperation rate in the long term is expected. 2,10,26 Nevertheless, topics such as the prediction of ETV success, 4,12,26,28,42 period of highest failure rate, 26 and late deterioration after ETV 7,29 are still topics of discussion. However, current data are scarce, and the long-term efficacy of ETV is often under debate, since most studies have reported a rather short follow-up period, e.g., 8 months 13 or a few years. 1,22,23,40 Very few studies exist with a significantly longer follow-up, e.g., 4 years.
35This study investigates very long term success rates, up to 16 years, and the incidence of failures in the early and long-term postoperative periods after ETV.
Methods
Study DesignThe long-term outcome of ETV was evaluated through a retrospective analysis of all patients who underwent an abbreviatioN ETV = endoscopic third ventriculostomy. SubMitteD February 22, 2014. accepteD November 25, 2014. iNcluDe wheN citiNg Published online July 31, 2015; DOI: 10.3171/2014.11.JNS14414. DiScloSure J. Oertel reports that he is a consultant for Karl Storz Co. The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. obJect Endoscopic third ventriculostomy (ETV) is the procedure of choice in the treatment of obstructive hydrocephalus. The excellent clinical and radiological success rates are well known. Nevertheless, very few papers have addressed the very long term outcomes of the procedure in very large series. The authors present a large case series of 113 patients who underwent 126 ETVs, and they highlight the initial postoperative outcome after 3 months and long-term follow-up with an average of 7 years. MethoDS All patients who underwent ETV at the Department of Neurosurgery, Mainz University Hospital, between 1993 and 1999 were evaluated. Obstructive hydrocephalus was the causative pathology in all cases. reSultS The initial clinical success rate was 82% and decreased slightly to 78% during long-term follow-up. Longterm success was analyzed using Kaplan-Meier curves. Overall, ETV failed in 31 patients. These patients underwent a second ETV or shunt treatment. A positive impact on long-term success was seen for age older than 6 months, and for obstruction due to cysts or benign aqueductal stenosis. The complication rate was 9% with 5 intraoperative and 5 postoperative events. coNcluSioNS The high clinical success rate in short-term and long-term follow-up confirms ETV's s...
