Endoscopic third ventriculostomy (ETV) is an endoscopic fenestration between the floor of the third ventricle and subarachnoid space. It is the procedure of choice for obstructive hydrocephalus (HC). The indication includes obstructive HC caused by aqueduct stenosis, tumors, brain infarction, cystic lesions, hematoma, postinfectious and posthemorrhagic HC, malformation of the fourth ventricle, and further uncommon indications. In this chapter, surgical techniques and the success rate of ETV in distinct indications will be presented and discussed. The overall success rate of ETV is reported at 60–90%. The outcome of the procedure depends highly on the underlying pathology and age. A very favorable outcome is reported in case of aqueduct stenosis (67–93.5%). High success rate is observed in case of cerebellar infarction (86%), tumors (56–81%), and intraventricular cysts (56–95%). In case of intraventricular hemorrhage (43–73%), infection (60–64%), anatomical aberration (21–80%), and communicating HC (65–72%), a significantly inferior success rate is reported. It is well known that ETV has a lower success rate in children (68–71%) compared to adults (70–90%). The overall high clinical success rate in short-term and long-term follow-up confirms that ETV is the gold standard for treatment of occlusive HC. It is effective, safe, and simple.
Part of the book: Hydrocephalus