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Endoscopic third ventriculostomy in infants.

OBJECT
The failure rate following endoscopic third ventriculostomy (ETV) in infants younger than 1 year of age has been reported to be higher compared with that of older children. The authors present results of ETVs in such infants and advocate that success or failure of the procedure depends not on the age of the patient but on the cause of the hydrocephalus.


METHODS
The authors retrospectively reviewed the management and outcome of 18 ETVs in infants for the treatment of hydrocephalus. The surgeries were performed between November 1996 and October 2002. The mean age at the time of surgery was 150 days (range 9-354 days). The minimal follow-up period was 18 months and the mean was 50 months. The authors divided the patients into the following three groups: obstructive hydrocephalus (four infants), communicating hydrocephalus (10 infants), and hydrocephalus associated with myelomeningocele (four infants). No perioperative death occurred, and perioperative transient morbidity related to ETV was low. The success of the procedure was determined by the cause of the hydrocephalus. Infants with obstructive hydrocephalus had a 100% success rate (four of four), and infants with communicating hydrocephalus had a 10% success rate (one of 10). In infants with hydrocephalus related to myelomeningocele, the success rate was 50% (two of four).


CONCLUSIONS
The authors conclude that ETV presents an effective alternative for the treatment of obstructive hydrocephalus in infants younger than 1 year of age. Age does not present a contraindication for ETV, nor does it increase the perioperative risk. The success of ETV is determined by the cause of the hydrocephalus.