Complications and risk factors of endoscopic third ventriculostomy: A 10-year single-centre study and systematic literature review

Abstract

Introduction

Endoscopic third ventriculostomy is considered a safe and low-risk treatment of obstructive hydrocephalus. No systematic review has been conducted recently to establish benchmarks for success and complication rates. This knowledge gap makes it difficult to evaluate local institutional performance against international results.

Research question

What are the results of endoscopic third ventriculostomy for obstructive hydrocephalus in the literature, and how does it compare to the results of our medium-sized neurosurgical center?

Material and methods

We performed a retrospective case series of patients treated at the Department of Neurosurgery, Haukeland University Hospital, from January 1, 2013, to December 31, 2023. A systematic review was performed in accordance with the PRISMA guidelines.

Results

Our case series consisted of 127 patients in a mixed-age cohort (mean: 37.3, range: 0–86) treated with endoscopic third ventriculostomy for hydrocephalus the last ten years. Previous shunting and neurosurgery were identified as risk factors for endoscopic third ventriculoscopy failure. In our systematic review, we found 64 reports with a total of 8409 patients eligible for inclusion. A higher success rate (78.7%) and complication rate (21.3%) were found in our patient material compared to the findings in our systematic review (respectively 73.4% and 11.6%). All complications in our material were transient and did not cause any permanent morbidity.

Discussion and conclusions

Endoscopic third ventriculostomy has a favorable safety profile with high success rates in the treatment of obstructive hydrocephalus. Results from our systematic review can be used for internal audits at other neurosurgical centers.