gms | German Medical Science

Objective: The endoscopic third ventriculostomy (ETV) is the Gold standard in the therapy of obstructive hydrocephalus. The initial excellent clinical and radiological outcome rate is notorious. Under current controversial discussion is the need and effectiveness of reventriculostomy. The authors evaluated a large patient series focussing on the effectiveness of reventriculostomy and highlight the inital and very long-term outcome.

Method: One-hundred-thirteen patients underwent a total of 126 ETVs at the department of neurosurgery in Mainz between 1993 and 1999. The authors performed a retrospective analysis of this database in 2010. Obstructive hydrocephalus was the causative pathology in all cases. All medical reports of patients, who received ETV were reviewed and analyzed with the focus on ETV failure with following re-ventriculostomy and ist long-term success.

Results: Thirty-one events of failure after ETV occurred during short and long-term follow-up. Thirteen patients underwent reventriculostomy, i.e. three patients during the first three months, the other ten patients after seven to 78 months (mean 33 months). Another 18 patients had shunt implantation. All reventriculostomies were performed without any complications. Long-term evaluation after successful reventriculostomy ranged from two months up to 14 years (average seven years). Long-term success rate of successful reventriculostomy after 3 months yielded 80%.

Conclusions: In view of these statistics it can be advocated that reventriculostomy is of value and furthermore effective after careful patient selection. The choice to perform re-ETV or implant a shunt system is based on surgeon’s preference and of course on the radiological findings.