The effect of primary endoscopic third ventriculostomy (ETV) for pediatric hydrocephalus on subsequent shunting remains unclear, particularly as to whether there is a protective or negative effect on subsequet shunting. The International Infant Hydrocephalus Study prospectively evaluated primary ETV in infants aged <24 months born at >36 weeks gestation with symptomatic hydrocephalus secondary to aqueductal stenosis, comparing these infants to those treated with primary shunting. In patients with ETV failure treated with subsequent shunting, over a median follow-up of 800 days, the rate of shunt failure (29.4%) was not significantly different than those patients treated with primary shunting (20.9%). On the other hand, the risk of failure of repeat ETV after failed ETV (75%) was high (but only used in 4 patients). These results indicate that a prior ETV does not affect survival of subsequent shunt placement and that in patients with ETV failure, the odds of developing subsequent treatment failure following secondary treatment, are not higher than having the alternative primary treatment. Data interpretation is limited by small sample size and low randomization.
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