• David S Hersh, Pooja Dave, Matt Weeks, Todd C Hankinson, Brandon Karimian, Susan Staulcup, Mark D Van Poppel, Scott D Wait, Brandy N Vaughn, and Paul Klimo.
• Department of Neurosurgery, The University of Tennessee Health Science Center, The University of Tennessee, Memphis, Tennessee.
• Neurosurgery. 2020 Aug 1; 87 (2): 285-293.

BackgroundEndoscopic third ventriculostomy (ETV) is an effective primary treatment for certain forms of hydrocephalus. However, its use in children with an existing shunt is less well known.ObjectiveTo report a multicenter experience in attempting to convert patients from shunt dependence to a third ventriculostomy and to determine predictors of success.MethodsThree participating centers provided retrospectively collected information on patients with an attempted conversion from a shunt to an ETV between December 1, 2008, and April 1, 2018. Demographic, clinical, and radiological data were recorded. Success was defined as shunt independence at the last follow-up.ResultsEighty patients with an existing ventricular shunt underwent an ETV. The median age at the time of the index ETV was 9.9 yr, and 44 (55%) patients were male. The overall success rate was 64% (51/80), with a median duration of follow-up of 2.0 yr (range, 0.1-9.4 yr). Four patients required a successful repeat ETV at a median of 1.7 yr (range, 0.1-5.7 yr) following the index ETV. Only age was predictive of ETV failure on multivariate analysis (odds ratio 0.86 [95% CI 0.78-0.94], P = .005). No patient less than 6 mo of age underwent an ETV, and of the 5 patients between 6 and 12 mo of age, 4 failed.ConclusionAlthough not every shunted patient will be a candidate for an ETV, nor will they be successfully converted, an ETV should at least be considered in every child who presents with a shunt malfunction or who has an externalized shunt.Copyright © 2019 by the Congress of Neurological Surgeons.

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