Article
Long term follow-up of repeat endoscopic third ventriculostomy in obstructive hydrocephalus
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Published: | June 9, 2017 |
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Objective: Endoscopic third ventriculostomy (ETV) for obstructive hydrocephalus provides excellent outcome. Nevertheless, repeat ETV in cases of ETV failure is under controversial discussion.
Methods: Between 1993 and 1999, 113 patients with obstructive hydrocephalus underwent a total of 126 ETVs at the Department of Neurosurgery, Mainz University Hospital. A very long term follow-up of up to 14 years could be achieved. All medical reports of patients who received ETV were reviewed and analyzed retrospectively with focus on ETV failure with following repeat ETV and its initial as well as very long term success.
Results: Of 31 patients with failure of initial ETV, 13 patients underwent repeat ETV: 3 patients during the first 3 months (early repeat ETV), the other 10 patients after 7 to 78 months (late repeat ETV, mean 33 months). All repeat ETVs were performed without complications. Follow-up evaluation after repeat ETV ranged from < 1 month up to 14 years (mean 7 years). Of the three early revisions, two ETV failed and one other patient died during follow up while only two of the late repeat ETV failed. Very long term success rate of late repeat ETV up to 14 years yielded 80%.
Conclusion: Repeat ETV in cases of late ETV failures represents an excellent treatment option for CSF circulation restoration up to 14 years of follow up. Repeat ETV in early ETV failure in contrast is disappointing; and factors of ETV failure should be analysed very carefully before a decision for repeat ETV is made.