Efficacy of Endoscopic Third Ventriculostomy in Pediatric Hydrocephalus: A Long-Term Outcome Study – 60 Cases

Abstract

Background: Pediatric hydrocephalus is a common neurosurgical condition, often managed with cerebrospinal fluid (CSF) diversion techniques. Endoscopic third ventriculostomy (ETV) has emerged as a minimally invasive alternative to ventriculoperitoneal shunt (VPS) placement, with potential long-term efficacy and reduced complication rates. Objective: To evaluate the long-term clinical and radiological outcomes of ETV in children with hydrocephalus and determine factors influencing procedural success. Materials and Methods: This retrospective-prospective study included 60 pediatric patients (age ≤18 years) who underwent ETV at our center between February- 2024 to March-2025. Patient demographics, etiology of hydrocephalus, intraoperative findings, and perioperative complications were recorded. Clinical outcomes were assessed using symptom resolution, neurological status, and need for subsequent CSF diversion. Radiological outcomes were evaluated via serial MRI/CT scans to assess ventricular size and stoma patency. Long-term follow-up ranged from 2 to 10 years. Statistical analysis was performed to identify predictors of ETV success. Results: Among 60 patients, 35 (58%) were male and 25 (42%) female, with a mean age of 4.7 ± 3.2 years. Etiologies included aqueductal stenosis (40%), post-infectious hydrocephalus (25%), myelomeningocele-related (20%), and other causes (15%). ETV was successful in 45 patients (75%), with sustained symptom improvement and stable ventricular size on follow-up. Complications were minimal, with intraoperative bleeding in 2 cases and transient hormonal disturbance in 1 case. Etiology (aqueductal stenosis) and age >1 year were significantly associated with higher success rates (p<0.05). Conclusion: ETV is a safe and effective treatment for pediatric hydrocephalus, particularly in older children and those with aqueductal stenosis. Long-term outcomes demonstrate durable symptom control and low complication rates, making ETV a viable alternative to shunt procedures.

Keywords: Endoscopic Third Ventriculostomy, Pediatric Hydrocephalus, Long-Term Outcome, CSF Diversion, Aqueductal Stenosis.