THE ROLE OF ENDOSCOPIC 3RD VENTRICULOSTOMY IN THE MANAGEMENT OF SHUNTMALFUNCTION

OBJECTIVE: To evaluate the effectiveness of third ventriculostomy as a n alternative to shunt revision in the management of shunt malfunction and infection in obstructive hydrocephalus. METHODS: All of the clini cal notes of 30 patients treated with third ventriculostomy for malfun ctioning or infected shunts between January 1, 1974, and December 31, 1996, were retrospectively reviewed. Third ventriculostomy was perform ed under fluoroscopic control in the first seven patients and endoscop ically in the remainder. A successful outcome was achieved if further shunt revision surgery was avoided. The median follow-up duration was 8.7 years. RESULTS: Twenty-three patients (76.7%) experienced successf ul outcomes, resulting in shunt independence. Of the seven failures, t hree were technical failures at the time of surgery and the remaining four were manifest within a median of 10 days, resulting in shunt revi sion. There have been no delayed failures. CONCLUSION: Third ventricul ostomy is a valuable alternative to shunt revision in patients affecte d by obstructive hydrocephalus presenting with shunt malfunction or in fection. It should be considered in all suitable cases as the first-li ne treatment for obstructive hydrocephalus of all causes. Because all failures were manifest within a short time, it is likely that these su ccesses will be durable.