Comparative Outcomes of Endoscopic Third Ventriculostomy vs. Ventriculoperitoneal Shunt in Treating Obstructive Hydrocephalus

Abstract

Background: Obstructive hydrocephalus, characterized by cerebrospinal fluid (CSF) accumulation due to flow obstruction, requires effective management to prevent neurological damage.

Objective: This study aimed to compare the clinical outcomes of Endoscopic Third Ventriculostomy (ETV) and Ventriculoperitoneal Shunt (VPS) in treating obstructive hydrocephalus.

Methodology: A prospective, comparative observational study was conducted at the Mardan Medical Complex Mardan,  KPK, Pakistan from January 2023 to December 2023. There were sixty patients getting VPS and sixty undergoing ETV. Data were gathered on follow-up, clinical outcomes, surgical complications, etiology of hydrocephalus, and demographics. Chi-square tests were used to compare categorical data, whereas descriptive statistics were used to describe patient features. To evaluate differences in continuous variables like the length of hospital stay, independent t-tests were used. P-values less than 0.05 were regarded as statistically significant.

Results: ETV achieved a higher success rate with 45 patients (75%) experiencing successful outcomes compared to 40 patients (66.67%) in the VPS group, though this difference was not statistically significant (p=0.30). The ETV group had fewer postoperative complications, with 2 infections (3.33%) and 1 CSF leak (1.67%), while the VPS group had 5 infections (8.33%) and 3 CSF leaks (5.00%). ETV also resulted in a significantly shorter hospital stay (mean 5.52 days) compared to VPS (mean 7.29 days, p=0.001). The number of revision surgeries was lower in the ETV group (mean 0.13) compared to the VPS group (mean 0.33, p=0.02). Long-term outcomes showed better results for ETV in terms of quality of life improvement and fewer recurrent symptoms.

Conclusion: In terms of success rates, complications, and length of hospital stay, ETV often provides better results than VPS for obstructive hydrocephalus; nevertheless, the decision of therapy should be based on the unique circumstances of each patient.