The initial treatment of hydrocephalus: An assessment of surgeons' preference between third ventriculostomy and shunt insertion

Third ventriculostomy is an option for patients who have traditionally rece ived a ventriculoperitoneal shunt This study has been conducted to determin e: 1. How common is third ventriculostomy as the initial treatment of hydro cephalus a. Does the frequency of third ventriculostomy vary among surgeons ! 3. What factors influence surgeons' decision to choose third ventriculost omy! Surgeons completed a questionnaire addressing patient selection and te chnique factors. Nine case scenarios were reviewed by surgeons who were the n asked to choose a ventriculoperitoneal shunt or a third ventriculostomy a s the initial treatment. Forty-three responses were received. The proportio n of new patients treated with third ventriculostomy varied widely (0%-100% , median 13%). This was not related to years in practice, type of training or presence of residents/fellows. Factors that increased the chance of a th ird ventriculostomy were triventricular hydrocephalus on CT/MR, isolated aq ueduct stenosis, thin ballooned floor and tectal tumor. Factors that decrea sed the chance of a third ventriculostomy were dilated subarachnoid spaces, meningitis and head injury. The presence of myelomeningocele or age < 1 ye ar were less likely to influence the choice of operation. Variation in the rate of third ventriculostomy as the first treatment for hydrocephalus is l arge. It is unlikely that this degree of variation can be explained by diff erences in patient populations. Further work to refine and disseminate the indications for third ventriculostomy is warranted.