Complications and failures of endoscopic third ventriculostomy: perception of their avoidance

ABSTRACT

Endoscopic third ventriculostomy [ETV] has been shown to be a sufficient alternative in the surgical treatment of occlusive hydrocephalus. The purpose of this study is to evaluate complications and failures of ETV and to define the factors that can minimize their occurrence or effects. A retrospective analysis was conducted for 40 patients [16 female and 24 male patients] in whom ETV was performed. Their age ranged from 6 months to 65 years [mean age, 9 years]. Hydrocephalus was caused by aqueductal stenosis in 23 patients [10 with previous shunts], and posterior fossa lesions in 17 patients. Endoscopic third ventriculostomy was performed in all patients using a freehand method. Forty-three ETVs were attempted in 40 cases and were completed in 42. There were no fatal outcomes related to ETV. The overall success rate was 72.5%. Complications were observed in 15 cases. Complicateions were CSF leak, fever, meningitis, transient diabetes insipidus, pseudomeningocele, pneumocephalus, haemorrhage and failures. Many complications can be avoided by determining the correct diagnosis and using suitable technique. Most complications can be managed conservatively and do not produce long-term morbidity. The complication rate decreases markedly with surgical experience, indicating a steep learning curve