Long term follow-up of repeat endoscopic third ventriculostomy in obstructive hydrocephalus.

OBJECTIVE Endoscopic third ventriculostomy (ETV) is a safe and less invasive treatment strategy for patients with obstructive hydrocephalus and provides excellent outcome. Nevertheless, repeat ETV in cases of ETV failure is a controversial issue. METHODS Between 1993 and 1999, 113 patients underwent a total of 126 ETVs at the Department of Neurosurgery, Mainz University Hospital. Obstructive hydrocephalus was the causative pathology in all cases. A very long term follow-up of up to 16 years could be achieved. All medical reports of patients who received ETV were reviewed and analyzed with focus on ETV failure with following repeat ETV and its initial as well as very long term success. RESULTS Thirty-one events of ETV failure occurred during the follow-up period. Thirteen patients underwent repeat ETV: three patients during the first 3 months (early repeat ETV), the other 10 patients after 7 to 78 months (late repeat ETV, mean 33 months). All repeat ETV were performed without complications. Follow-up evaluation after successful repeat ETV ranged from < 1 month up to 14 years (mean 7 years). Of the three early revisions, two failed and one other patient died during follow-up while only two of the late repeat ETV failed. Very long term success rate of late repeat ETV up to 14 years yielded 80%. CONCLUSIONS Repeat ETV in cases of late ETV failures represents an excellent option for CSF circulation restoration up to 14 years of follow-up. Repeat ETV in early ETV failure in contrast is not favored by the performing surgeons; and factors of ETV failure should be analyzed very carefully before a decision for repeat ETV is made