ENDOSCOPIC THIRD VENTRICULOSTOMY VERSUS VENTRICULOPERITONEAL SHUNT IN MANAGEMENT OF NON COMMUNICATING HYDROCEPHALUS IN CHILDREN

Abstract

Hydrocephalus is the most common disease treated by pediatric neurosurgeons. Shunt systems and endoscopic procedures have existed since the infancy of neurosurgery. Unlike communicating hydrocephalus, this condition has two treatment modalities, each with proponents. Although ETV was performed as early as the 1920s, with the advent of shunt catheters and valves, this procedure fell out of favor. There was a revitalization in the endoscopic technique with the advances in optics and instrumentation. Although the surgical techniques for shunt placement are well established and performed around the world, long-term complications, such as malfunction and infection, are significantly higher in this population. These children are dependent upon the shunt system for their CSF diversion, and it is well known that these systems do fail. ETV success rates have usually been measured in terms of “shunt freedom.” Comparisons between centers and pathologic groups have been hampered by the lack of uniformity for both inclusion criteria and failure definitions.