COMPARATIVE OUTCOMES OF ENDOSCOPIC THIRD VENTRICULOSTOMY AND VENTRICULOPERITONEAL SHUNTING IN OBSTRUCTIVE HYDROCEPHALUS

Abstract

Background: Obstructive hydrocephalus is characterized by impaired cerebrospinal fluid (CSF) circulation secondary to obstruction within the ventricular system. Endoscopic third ventriculostomy (ETV) provides an alternative CSF diversion pathway without implantation of a permanent shunt, whereas ventriculoperitoneal shunting (VPS) remains a widely used treatment. Objective: To compare the effectiveness and safety of ETV versus VPS in patients with obstructive hydrocephalus. Methods: This comparative study included 135 patients aged 4–60 years with radiologically confirmed obstructive hydrocephalus who underwent CSF diversion. Patients were allocated to an ETV group (n=68) or VPS group (n=67). Demographic characteristics, age distribution, etiology of hydrocephalus, operative duration, postoperative hospital stay, symptom improvement, radiological improvement, complications, and treatment failure requiring additional CSF diversion were assessed. Patients were followed for 12 months. Results: Patients ranged in age from 4 to 60 years, with 25 (18.5%) aged 4–12 years, 24 (17.8%) aged 13–18 years, 62 (45.9%) aged 19–40 years, and 24 (17.8%) aged 41–60 years. Clinical improvement was observed in 61 (89.7%) patients after ETV and 59 (88.1%) after VPS (p=0.76). Mean postoperative hospital stay was significantly shorter following ETV than VPS (3.8±1.6 vs. 6.1±2.4 days; p<0.001). Overall treatment failure occurred in 9 (13.2%) ETV patients and 13 (19.4%) VPS patients (p=0.34). The overall complication rate was 11.8% after ETV compared with 25.4% after VPS (p=0.048). Conclusion: ETV was associated with a shorter hospital stay and fewer procedure-related complications and avoided implantation of a permanent shunt. Age-stratified outcomes suggested favorable results in younger and middle-aged patients, while success was comparatively lower in the 41–60-year subgroup. In appropriately selected patients with anatomically suitable obstructive hydrocephalus, ETV may be preferred as a primary CSF diversion procedure.