Outcomes of Endoscopic Third Ventriculostomy in Treating Obstructive Hydrocephalus

Main Article Content

Shakeel Ahmed
Malik Liaqat Ali Jalal
Muhammad Irshad
Rizwan Shareef
Hamza Bashir


Background: Obstructive hydrocephalus poses significant treatment challenges, often necessitating innovative surgical interventions to alleviate symptoms and improve patient outcomes. Endoscopic third ventriculostomy (ETV) has emerged as a viable alternative to traditional shunting procedures, offering the promise of a less invasive approach with potentially lower complication rates. This study seeks to deepen our understanding of ETV's effectiveness and safety, shedding light on its role in the current treatment paradigm for obstructive hydrocephalus.

Objective: The primary objective of this investigation was to evaluate the surgical outcomes of ETV in patients with obstructive hydrocephalus, focusing on changes in the severity of hydrocephalus and the presence of comorbid conditions pre- and postoperatively.

Methods: A comprehensive retrospective analysis was conducted on 54 patients who underwent ETV for obstructive hydrocephalus. Patients were selected based on specific inclusion and exclusion criteria to ensure a homogenous study population. Preoperative and postoperative assessments included the severity of hydrocephalus and the identification of comorbid conditions, with outcomes measured at 6 and 12 months post-surgery. Statistical analyses employed included Chi-square tests for categorical variables, with a significance level set at p<0.05.

Results: Postoperative evaluations revealed a significant reduction in the severity of hydrocephalus, with 59% of patients categorized as mild post-surgery compared to 37% pre-surgery. Severe hydrocephalus was reduced from 30% to 11%. However, the presence of comorbid conditions showed no significant change postoperatively (41% pre-surgery vs. 37% post-surgery, p>0.05). The complication rate was minimal, indicating the procedure's safety.

Conclusion: ETV demonstrated a significant positive impact on reducing the severity of hydrocephalus in patients, confirming its efficacy as a treatment option. However, its effect on comorbid conditions was less pronounced, suggesting a need for integrated care strategies. These findings support the continued use and further study of ETV in the treatment of obstructive hydrocephalus.

Article Details

How to Cite
Ahmed, S., Jalal, M. L. A., Irshad, M., Shareef, R., & Bashir, H. (2024). Outcomes of Endoscopic Third Ventriculostomy in Treating Obstructive Hydrocephalus. Journal of Health and Rehabilitation Research, 4(1), 1536–1541. https://doi.org/10.61919/jhrr.v4i1.696
Author Biographies

Shakeel Ahmed, Children Complex Multan Pakistan

Associate Professor, Paeds Neurosurgery Department, Children Complex Multan Pakistan

Malik Liaqat Ali Jalal, Nishtar Medical University Multan Pakistan

Associate Professor, Neurosurgery Department, Nishtar Medical University Multan Pakistan

Muhammad Irshad, Nishter Medical University Multan Pakistan.

Assistant Professor of Neurosurgery, Nishter Medical University Multan Pakistan.

Rizwan Shareef, Allama Iqbal Teaching hospital DG khan Pakistan

Assistant Professor, Neurosurgery Department, Allama Iqbal Teaching hospital DG khan Pakistan

Hamza Bashir, Bakhtawar Amin Hospital Multan Pakistan

Medical Officer, Bakhtawar Amin Hospital Multan Pakistan


Chimaliro S, Hara C, Kamalo PJAN. Mortality and complications 1 year after treatment of hydrocephalus with endoscopic third ventriculostomy and ventriculoperitoneal shunt in children at Queen Elizabeth Central Hospital, Malawi. 2023;165(1):61-9.

Ikwuegbuenyi CA, Zolo Y, Nyalundja AD, Ngoma P, Abu-Bonsrah N, Kanmounye US, et al. Implementing evidence-based interventions for managing pediatric hydrocephalus: a systematic review protocol. 2023;2023(1):snac026.

Vadset TA, Rajaram A, Hsiao C-H, Kemigisha Katungi M, Magombe J, Seruwu M, et al. Improving infant hydrocephalus outcomes in Uganda: a longitudinal prospective study protocol for predicting developmental outcomes and identifying patients at risk for early treatment failure after ETV/CPC. 2022;12(1):78.

Van De Lande LS, Breakey RW, Borghi A, O’hara J, James G, Ong JL, et al. 47 th Annual Meeting of the International Society for Pediatric Neurosurgery. 2019;35:1925-2020.

Lim J, Tang AR, Liles C, Hysong AA, Hale AT, Bonfield CM, et al. The cost of hydrocephalus: a cost-effectiveness model for evaluating surgical techniques. 2018;23(1):109-18.

Isaacs AM, Williams MA, Hamilton MGJB, Elderly SSit. Hydrocephalus in the elderly: surgical management of idiopathic normal pressure hydrocephalus. 2017:469-500.

Masina R, Ansaripour A, Beneš V, Berhouma M, Choque-Velasquez J, Eide PK, et al. Surgical treatment of symptomatic pineal cysts without hydrocephalus—meta-analysis of the published literature. 2022:1-17.

Low SY, Kestle JR, Walker ML, Seow WTJCsNS. Cerebrospinal fluid shunt malfunctions: A reflective review. 2023;39(10):2719-28.

Oertel M, Csokonay AJHWotB. Presentation of the success rate of ETV in distinct indication cases of hydrocephalus. 2018:127.

Lee KS, Chari A, Gillespie CS, Ekert JO, Saffari SE, James G, et al. Endoscopic third ventriculostomy for shunt malfunction in the pediatric population: a systematic review, meta-analysis, and meta-regression analysis. 2023;31(5):423-32.

Tuniz F, Fabbro S, Piccolo D, Vescovi MC, Bagatto D, Cramaro A, et al. Long-standing overt ventriculomegaly in adults (LOVA): diagnostic aspects, CSF dynamics with lumbar infusion test and treatment options in a consecutive series with long-term follow-up. 2021;156:e30-e40.

Jung T-Y, Chong S, Kim I-Y, Lee JY, Phi JH, Kim S-K, et al. Prevention of complications in endoscopic third ventriculostomy. 2017;60(3):282.

Thomale U-W. Hydrocephalus and Surgical Solutions for It. Pediatric Neurosurgery Board Review: A Comprehensive Guide: Springer; 2023. p. 31-51.

Ellenbogen JR, Kandasamy J, Mallucci CLJPSGP, Surgery N. Hydrocephalus. 2020:1237-55.

Patel SK, Tari R, Mangano FTJPC. Pediatric hydrocephalus and the primary care provider. 2021;68(4):793-809.

Lo WB, Mathieu F, Riva-Cambrin J, Kestle JR, Kulkarni AV. Using Multicenter Clinical Registries to Improve Outcomes. Quality and Safety in neurosurgery: Elsevier; 2018. p. 141-67.

Janjua MB, Hoffman CE, Souweidane MMJJoCN. Contemporary management and surveillance strategy after shunt or endoscopic third ventriculostomy procedures for hydrocephalus. 2017;45:18-23.

Spacca B, Luglietto D, Vatavu O, D’Incerti L, Tuccinardi G, Butti D, et al. Operational Improvement in Pediatric Neurosurgery. Frailty in Children: From the Perioperative Management to the Multidisciplinary Approach: Springer; 2023. p. 159-89.

Budohoski KP, Ngerageza JG, Austard B, Fuller A, Galler R, Haglund M, et al. Neurosurgery in East Africa: innovations. 2018;113:436-52.

Meyer-Szary J, Luis MS, Mikulski S, Patel A, Schulz F, Tretiakow D, et al. The role of 3D printing in planning complex medical procedures and training of medical professionals—cross-sectional multispecialty review. 2022;19(6):3331.

Athanasiou A, Meling TR, Brotis A, Moiraghi A, Fountas K, Bamidis PD, et al. 3D printing in neurosurgery. 3D Printing: Applications in Medicine and Surgery Volume 2: Elsevier; 2022. p. 159-94.

Ganguli A, Pagan-Diaz GJ, Grant L, Cvetkovic C, Bramlet M, Vozenilek J, et al. 3D printing for preoperative planning and surgical training: a review. 2018;20:1-24.

Parthasarathy J, Krishnamurthy R, Ostendorf A, Shinoka T, Krishnamurthy RJJoMRI. 3D printing with MRI in pediatric applications. 2020;51(6):1641-58.

Lu L, Chen H, Weng S, Xu YJWn. Endoscopic third ventriculostomy versus ventriculoperitoneal shunt in patients with obstructive hydrocephalus: meta-analysis of randomized controlled trials. 2019;129:334-40.

Gholampour S, Bahmani M, Shariati AJB, Neuroscience C. Comparing the efficiency of two treatment methods of hydrocephalus: shunt implantation and endoscopic third ventriculostomy. 2019;10(3):185.

Guida L, Roux F-E, Massimino M, Marras CE, Sganzerla E, Giussani CJWN. Safety and efficacy of endoscopic third ventriculostomy in diffuse intrinsic pontine glioma related hydrocephalus: a systematic review. 2019;124:29-35.

Dhandapani M, Yagnick NS, Mohanty M, Ahuja CK, Dhandapani SJNI. Clinical outcome, cognitive function, and quality of life after endoscopic third ventriculostomy versus ventriculo-peritoneal shunt in non-tumor hydrocephalus. 2021;69(Suppl 2):S556-S60.

Manikandan S, Nair PJFoPN. Anesthesia for Minimally Invasive Neurosurgical Procedures in Children. 2021:321-41.

Silva AH, Aquilina KJC, Reviews M. Surgical approaches in pediatric neuro-oncology. 2019;38(4):723-47.

Mohamed M, Mediratta S, Chari A, da Costa CS, James G, Dawes W, et al. Post-haemorrhagic hydrocephalus is associated with poorer surgical and neurodevelopmental sequelae than other causes of infant hydrocephalus. 2021;37(11):3385-96.

Zhang L, Hussain Z, Ren ZJCdt. Recent advances in rational diagnosis and treatment of normal pressure hydrocephalus: a critical appraisal on novel diagnostic, therapy monitoring and treatment modalities. 2019;20(10):1041-57.

Petrella G, Ciarlo S, Taddei G, Pompucci A, Pesce A, D’Antona L, et al. fifteenth meeting of the Hydrocephalus Society. 2024.

Sunderland G, Ellenbogen J, Mallucci C. Hydrocephalus. Pediatric Surgery: Diagnosis and Management: Springer; 2023. p. 499-525.

Ellenbogen JR, Mallucci CJS. Management of cerebrospinal fluid disorders. 2021;39(8):504-13.

Deopujari CE, Karmarkar VS, Shaikh STJJoKNS. Endoscopic third ventriculostomy: success and failure. 2017;60(3):306.

Most read articles by the same author(s)