Neuroendoscopic third ventriculostomy for failed shunts.

Background: Neuroendoscopic third ventriculostomy has increased in frequency for the management of hydrocephalus. The objective of this paper is to study the outcome in patients with hydrocephalus whose shunt subsequently failed and who were treated with neuroendoscopic third ventriculostomy (NTV).

Method: The departmental prospectively acquired database, kept since 1994, was researched to identify those patients who underwent NTV, having presented with a failed shunt. Subsequent failure of the NTV occurs when further treatment for the hydrocephalus is required.

Results: There were 88 patients identified, 45(51%) male and 43(49%) female. Median age at time of NTV was 14 years (range 1 day to 69 years). Median time from last shunt to NTV was 8 years (1 week to 35 years). Follow-up was for a median of 3 years (1 month to 6 years) after their NTV. Overall 42 (48%) failed and 46 (52%) were successful. In those with noncommunicating causes the success rate was 73%. Median time to failure was 1 month (immediate to 5 years) Median age of failed patients at time of NTV was 7 years. Serious complications occurred in 5 (5.6%).

Conclusion: NTV in patients having previously been shunted for their hydrocephalus is safe and as successful as in primary NTV. Failure can be expected to occur with greater frequency in communicating than noncommunicating types of hydrocephalus. The fact that they have a malfunctioning shunt in situ is not a contraindication to this procedure. In cases of infected shunts it is a useful adjunct to the treatment of the infection.