Endoscopic third ventriculostomy in obstructive infantile hydrocephalus: remarks about the so-called 'unsuccessful cases'.

BACKGROUND: The failure rate following endoscopic third ventriculostomy (ETV) in infants younger than 2 years of age has been reported to be higher compared with that of older children, and it is unclear whether ETV might be superior to shunt placement in this age group.
METHODS: Between 2003 and 2009, 23 patients younger than 6 months and without a previous history of shunting underwent ETV in our institution. A review of the literature was performed on the basis of publications presenting detailed data on age and etiology in every single patient.
RESULTS: In our own patients, total success rate was 39.1%. In the successful cases, median age was 140 days, whereas in the unsuccessful cases it was 47 days. The difference between the two groups was statistically significant (p = 0.01). The median ages of both successful and unsuccessful groups corresponded to data gained from an analysis of the literature (p = 0.04). At a median follow-up of 47 months, 2 out of 14 patients shunted after a failed ETV were revised for ventriculoperitoneal shunt malfunction.
CONCLUSION: The impact of age on ETV failure in infants is clear and becomes crucial during the first 2 months of life, even when excluding etiological factors. Nevertheless, age cannot be considered the only parameter of the decision-making process, especially in these very young patients. Probably, the definition of 'unsuccessful ETV' should be reevaluated in light of decreased risk of shunt malfunction observed after a failed ETV.