Investigating Prognostic Factors for Primary Endoscopic Third Ventriculostomy in Adults and Elderly Patients with Noncommunicating Hydrocephalus.

Abstract

Endoscopic third ventriculostomy (ETV) is a well-established treatment for obstructive hydrocephalus, offering durable cerebrospinal fluid diversion without the long-term risks of shunt dependency. While prognostic factors such as patient age, etiology, ETV Success Score (ETV-SS), and radiological signs of third ventricle bowing are validated in pediatric cohorts, their predictive value in adults and elderly patients remains unclear. Adult patients diagnosed with obstructive hydrocephalus and consecutively treated with primary ETV were retrospectively evaluated. The primary endpoint was the evaluation of preoperative predictors of shunt failure in adult and elderly patients undergoing primary ETV after a long-term follow-up. ETV-SS and radiological parameters including ventricular morphometrics were preoperatively evaluated. Outcomes included postoperative clinical improvement, complications, and rate of ETV failure requiring revision surgery. A total of 51 patients (mean age 60 ± 16 years) were included, with a median follow-up of 24 months. Most patients presented with high preoperative ETV-SS (≥80). Favorable outcomes with effective stoma patency were achieved in 85% of the cases. Overall, 8 (16%) patients required revision surgery for ETV failure, with a median interval to surgical revision of 6.5 months. ETV-SS, age, gender, etiology, and ventricular morphometrics showed limited correlation with long-term outcome. In adult and elderly patients undergoing primary ETV for obstructive hydrocephalus, none of the evaluated prognostic factors - including the ETV-SS, hydrocephalus etiology, and third ventricle morphometrics - were predictive of postoperative outcome. ETV was shown to be a safe and effective treatment across age groups and preoperative diagnoses.