• Mino Zucchelli, Francesca Nicolini, Francesco Toni, Monica Maffei, Giorgio Palandri, and Ercole Galassi.
• IRCCS Istituto delle Scienze Neurologiche di Bologna, Pediatric Neurosurgery, Bologna, Italy. Electronic address: minoz@inwind.it.
• World Neurosurg. 2019 May 1; 125: e229-e235.

Objective/BackgroundThe natural history and the outlook of patients with hydrocephalus are dramatically affected using cerebrospinal fluid shunts. The several issues related with a long-standing shunt should suffice to justify all the possible attempts to free the patient from it. This study focused on the role of secondary endoscopic third ventriculostomy (ETV) in the achievement of shunt removal in cases of shunt malfunction, and to identify patients who could benefit most from the procedure.MethodsIn the period of 2006-2015, ETV was attempted in 47 patients >6 months old with ventriculoperitoneal shunt malfunction who presented with increased ventricle size compared with the previous neuroradiological examinations; simultaneously the shunt was removed or ligated.ResultsThe overall success rate of secondary ETV was 74% (shunt-free patients with normalized intracranial pressure and absence of symptoms attributable to hydrocephalus) in patients with a long shunt duration (up to 30 years). The number of previous shunt revision procedures (P = 0.026) and lower age (P = 0.017) correlate with the likelihood of secondary ETV failure, a score of 80 as ETV success score (calculated for both pediatric and adult patients, even if the score was meant for the pediatric population) correlates with secondary ETV success (P = 0.014).ConclusionsMany patients with shunt malfunction can benefit from secondary ETV even after decades of shunting. Age at secondary ETV, the number of previous shunt revisions, and the ETV success score can help to better identify the best candidates for the procedure.Copyright © 2019 Elsevier Inc. All rights reserved.

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