{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T22:32:04Z","timestamp":1790721124682,"version":"4.1.0"},"reference-count":72,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2016,9]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>The efficacy of endoscopic third ventriculostomy (ETV) for the treatment of pediatric hydrocephalus has been extensively reported in the literature. However, ETV-related long-term outcome data are lacking for the adult hydrocephalus population. The objective of the present study was to assess the role of ETV as a primary or secondary treatment for hydrocephalus in adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The authors performed a retrospective chart review of all adult patients (age \u2265 18 years) with symptomatic hydrocephalus treated with ETV in Calgary, Canada, over a span of 20 years (1994\u20132014). Patients were dichotomized into a primary or secondary ETV cohort based on whether ETV was the initial treatment modality for the hydrocephalus or if other CSF diversion procedures had been previously attempted respectively. Primary outcomes were subjective patient-reported clinical improvement within 12 weeks of surgery and the need for any CSF diversion procedures after the initial ETV during the span of the study. Categorical and actuarial data analysis was done to compare the outcomes of the primary versus secondary ETV cohorts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>A total of 163 adult patients with symptomatic hydrocephalus treated with ETV were identified and followed over an average of 98.6 months (range 0.1\u2013230.4 months). All patients presented with signs of intracranial hypertension or other neurological symptoms. The primary ETV group consisted of 112 patients, and the secondary ETV consisted of 51 patients who presented with failed ventriculoperitoneal (VP) shunts. After the initial ETV procedure, clinical improvement was reported more frequently by patients in the primary cohort (87%) relative to those in the secondary ETV cohort (65%, p = 0.001). Additionally, patients in the primary ETV group required fewer reoperations (p &lt; 0.001), with cumulative ETV survival time favoring this primary ETV cohort over the course of the follow-up period (p &lt; 0.001). Fifteen patients required repeat ETV, with all but one experiencing successful relief of symptoms. Patients in the secondary ETV cohort also had a higher incidence of complications, with one occurring in 8 patients (16%) compared with 2 in the primary ETV group (2%; p = 0.010), although most complications were minor.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>ETV is an effective long-term treatment for selected adult patients with hydrocephalus. The overall ETV success rate when it was the primary treatment modality for adult hydrocephalus was approximately 87%, and 99% of patients experience symptomatic improvement after 2 ETVs. Patients in whom VP shunt surgery fails prior to an ETV have a 22% relative risk of ETV failure and an almost eightfold complication rate, although mostly minor, when compared with patients who undergo a primary ETV. Most ETV failures occur within the first 7 months of surgery in patients treated with primary ETV, but the time to failure is more prolonged in patients who present with failed previous shunts.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2016.6.focus16193","type":"journal-article","created":{"date-parts":[[2016,9,1]],"date-time":"2016-09-01T03:39:30Z","timestamp":1472701170000},"page":"E3","source":"Crossref","is-referenced-by-count":56,"title":["Endoscopic third ventriculostomy for treatment of adult hydrocephalus: long-term follow-up of 163 patients"],"prefix":"10.3171","volume":"41","author":[{"given":"Albert M.","family":"Isaacs","sequence":"first","affiliation":[{"name":"Division of Neurosurgery, Department of Clinical Neuroscience;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yarema B.","family":"Bezchlibnyk","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Clinical Neuroscience;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather","family":"Yong","sequence":"additional","affiliation":[{"name":"University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dilip","family":"Koshy","sequence":"additional","affiliation":[{"name":"Cumming School of Medicine;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geberth","family":"Urbaneja","sequence":"additional","affiliation":[{"name":"Adult Hydrocephalus Program, Department of Clinical Neuroscience;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walter J.","family":"Hader","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Clinical Neuroscience;"},{"name":"Pediatric Neurosurgery Program, Department of Clinical Neuroscience, University of Calgary, Alberta; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark G.","family":"Hamilton","sequence":"additional","affiliation":[{"name":"Adult Hydrocephalus Program, Department of Clinical Neuroscience;"},{"name":"Division of Neurosurgery, Department of Clinical Neuroscience;"},{"name":"Pediatric Neurosurgery Program, Department of Clinical Neuroscience, University of Calgary, Alberta; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"6","key":"b1-focus16193","series-title":"Neurosurg Focus","first-page":"E9","article-title":"Endoscopic third ventriculostomy in a series of 36 adult patients","volume":"19","author":"Amini","year":"2005"},{"key":"b2-focus16193","series-title":"J Neurosurg","first-page":"1032","article-title":"Endoscopic third ventriculostomy for shunt dysfunction in occlusive hydrocephalus: long-term follow up and review","volume":"98","author":"Boschert","year":"2003"},{"key":"b3-focus16193","series-title":"Pediatr Neurol","first-page":"83","article-title":"Failure of cerebrospinal fluid shunts: part I: Obstruction and mechanical failure","volume":"34","author":"Browd","year":"2006"},{"key":"b4-focus16193","series-title":"World Neurosurg","first-page":"970","article-title":"Third ventriculocisternostomy for shunt failure","volume":"83","author":"Chhun","year":"2015"},{"key":"b5-focus16193","series-title":"Neurosurgery","first-page":"129","article-title":"Endoscopic third ventriculostomy in idiopathic normal pressure hydrocephalus","volume":"55","author":"Gangemi","year":"2004"},{"key":"b6-focus16193","series-title":"Neurosurgery","first-page":"62","article-title":"Endoscopic third ventriculostomy in idiopathic normal pressure hydrocephalus: an Italian multicenter study","volume":"63","author":"Gangemi","year":"2008"},{"key":"b7-focus16193","series-title":"Minim Invasive Neurosurg","first-page":"265","article-title":"Long-term outcome of endoscopic third ventriculostomy in obstructive hydrocephalus","volume":"50","author":"Gangemi","year":"2007"},{"key":"b8-focus16193","series-title":"Clin Neurol Neurosurg","first-page":"92","article-title":"Ventriculocisternostomy versus ventriculoperitoneal shunt in the treatment of hydrocephalus: a retrospective, long-term observational study","volume":"122","author":"Gliemroth","year":"2014"},{"key":"b9-focus16193","series-title":"Neurosurgery","first-page":"109","article-title":"Endoscopic third ventriculostomy in 250 adults with hydrocephalus: patient selection, outcomes, and complications","volume":"78","author":"Grand","year":"2016"},{"key":"b10-focus16193","series-title":"Can J Neurol Sci","first-page":"729","article-title":"Neuropsychological outcome after endoscopic third ventriculostomy","volume":"41","author":"Hader","year":"2014"},{"issue":"1 Suppl 1","key":"b11-focus16193","series-title":"Neurosurgery","first-page":"ONS168","article-title":"Complications of endoscopic third ventriculostomy in previously shunted patients","volume":"63","author":"Hader","year":"2008"},{"key":"b12-focus16193","series-title":"Semin Pediatr Neurol","first-page":"34","article-title":"Treatment of hydrocephalus in adults","volume":"16","author":"Hamilton","year":"2009"},{"key":"b13-focus16193","series-title":"J Neurosurg","first-page":"861","article-title":"The role of endoscopic third ventriculostomy in adult patients with hydrocephalus","volume":"110","author":"Jenkinson","year":"2009"},{"key":"b14-focus16193","series-title":"Malawi Med J","first-page":"78","article-title":"Exit ventriculoperitoneal shunt; enter endoscopic third ventriculostomy (ETV): contemporary views on hydrocephalus and their implications on management","volume":"25","author":"Kamalo","year":"2013"},{"issue":"2 Suppl","key":"b15-focus16193","series-title":"World Neurosurg","first-page":"S22.e1","article-title":"Third ventriculostomy in normal pressure hydrocephalus","volume":"79","author":"Kandasamy","year":"2013"},{"key":"b16-focus16193","series-title":"J Neurosurg Pediatr","first-page":"310","article-title":"Predicting who will benefit from endoscopic third ventriculostomy compared with shunt insertion in childhood hydrocephalus using the ETV Success Score","volume":"6","author":"Kulkarni","year":"2010"},{"key":"b17-focus16193","series-title":"J Neurosurg Pediatr","first-page":"11","article-title":"Quality of life after endoscopic third ventriculostomy and cerebrospinal fluid shunting: an adjusted multivariable analysis in a large cohort","volume":"6","author":"Kulkarni","year":"2010"},{"key":"b18-focus16193","series-title":"J Neurosurg","first-page":"1447","article-title":"Predicting success of endoscopic third ventriculostomy: validation of the ETV Success Score in a mixed population of adult and pediatric patients","volume":"123","author":"Labidi","year":"2015"},{"key":"b19-focus16193","series-title":"Neurochirurgie","first-page":"165","article-title":"Endoscopic 3rd ventriculocisternostomy: procedural complications and long-term dysfunctions?","volume":"59","author":"Melot","year":"2013"},{"key":"b20-focus16193","series-title":"Acta Neurochir Suppl","first-page":"25","article-title":"Ten years of clinical experience in the use of fixed-pressure versus programmable valves: a retrospective study of 159 patients","volume":"113","author":"Mpakopoulou","year":"2012"},{"key":"b21-focus16193","series-title":"J Neurosurg","first-page":"151","article-title":"Laparoscopic versus open insertion of the peritoneal catheter in ventriculoperitoneal shunt placement: review of 810 consecutive cases","volume":"115","author":"Naftel","year":"2011"},{"key":"b22-focus16193","series-title":"J Surg Res","first-page":"140","article-title":"Shunting for hydrocephalus: analysis of techniques and failure patterns","volume":"191","author":"Nigim","year":"2014"},{"key":"b23-focus16193","series-title":"Clin Neurol Neurosurg","first-page":"48","article-title":"Results of endoscopic third ventriculostomy in elderly patients \u226565 years of age","volume":"130","author":"Niknejad","year":"2015"},{"key":"b24-focus16193","series-title":"Childs Nerv Syst","first-page":"181","article-title":"Neurological and medico-social problems of spina bifida patients in adolescence and adulthood","volume":"12","author":"Oi","year":"1996"},{"key":"b25-focus16193","series-title":"J Neurosurg Pediatr","first-page":"722","article-title":"Complications and subsequent removal of retained shunt hardware after endoscopic third ventriculostomy: case series","volume":"11","author":"Pindrik","year":"2013"},{"key":"b26-focus16193","series-title":"World Neurosurg","first-page":"555","article-title":"The role of endoscopic third ventriculostomy in the treatment of communicating hydrocephalus","volume":"77","author":"Rangel-Castilla","year":"2012"},{"key":"b27-focus16193","series-title":"Neurosurgery","first-page":"774","article-title":"Management of adult hydrocephalus with ventriculoperitoneal shunts: long-term single-institution experience","volume":"69","author":"Reddy","year":"2011"},{"key":"b28-focus16193","series-title":"Establishing the Diagnosis of Shunt Independence","first-page":"223","author":"Rekate","year":"1982"},{"key":"b29-focus16193","series-title":"Clin Neurol Neurosurg","first-page":"130","article-title":"Endoscopic third ventriculostomy in the management of hydrocephalus: Outcome analysis of 168 consecutive procedures","volume":"126","author":"Salvador","year":"2014"},{"key":"b30-focus16193","series-title":"J Neurosurg","first-page":"1058","article-title":"Laparoscopically assisted ventriculoperitoneal shunt placement: a prospective randomized controlled trial","volume":"122","author":"Schucht","year":"2015"},{"key":"b31-focus16193","series-title":"Neurosurg Rev","article-title":"Endoscopic third ventriculostomy in the treatment of idiopathic normal pressure hydrocephalus: a review study","author":"Tasiou","year":"2015"},{"key":"b32-focus16193","series-title":"Cochrane Database Syst Rev","first-page":"CD010033","article-title":"Endoscopic third ventriculostomy (ETV) for idiopathic normal pressure hydrocephalus (iNPH)","volume":"7","author":"Tudor","year":"2015"},{"key":"b33-focus16193","series-title":"J Neurosurg","first-page":"1456","article-title":"Long-term results of endoscopic third ventriculostomy: an outcome analysis","volume":"123","author":"Vulcu","year":"2015"},{"key":"b34-focus16193","series-title":"Tech Neurosurg","first-page":"219","article-title":"Shunt removal: is it ever worth the risks?","volume":"7","author":"Whitehead","year":"2002"},{"key":"b35-focus16193","series-title":"Neurol Res","first-page":"27","article-title":"Prior CSF shunting increases the risk of endoscopic third ventriculostomy failure in the treatment of obstructive hydrocephalus in adults","volume":"29","author":"Woodworth","year":"2007"},{"key":"b36-focus16193","series-title":"World Neurosurg","first-page":"312","article-title":"Predictors of surgery-free outcome in adult endoscopic third ventriculostomy","volume":"78","author":"Woodworth","year":"2012"},{"issue":"6","key":"b1-focus16193","series-title":"Neurosurg Focus","first-page":"E9","article-title":"Endoscopic third ventriculostomy in a series of 36 adult patients","volume":"19","author":"Amini","year":"2005"},{"key":"b2-focus16193","series-title":"J Neurosurg","first-page":"1032","article-title":"Endoscopic third ventriculostomy for shunt dysfunction in occlusive hydrocephalus: long-term follow up and review","volume":"98","author":"Boschert","year":"2003"},{"key":"b3-focus16193","series-title":"Pediatr Neurol","first-page":"83","article-title":"Failure of cerebrospinal fluid shunts: part I: Obstruction and mechanical failure","volume":"34","author":"Browd","year":"2006"},{"key":"b4-focus16193","series-title":"World Neurosurg","first-page":"970","article-title":"Third ventriculocisternostomy for shunt failure","volume":"83","author":"Chhun","year":"2015"},{"key":"b5-focus16193","series-title":"Neurosurgery","first-page":"129","article-title":"Endoscopic third ventriculostomy in idiopathic normal pressure hydrocephalus","volume":"55","author":"Gangemi","year":"2004"},{"key":"b6-focus16193","series-title":"Neurosurgery","first-page":"62","article-title":"Endoscopic third ventriculostomy in idiopathic normal pressure hydrocephalus: an Italian multicenter study","volume":"63","author":"Gangemi","year":"2008"},{"key":"b7-focus16193","series-title":"Minim Invasive Neurosurg","first-page":"265","article-title":"Long-term outcome of endoscopic third ventriculostomy in obstructive hydrocephalus","volume":"50","author":"Gangemi","year":"2007"},{"key":"b8-focus16193","series-title":"Clin Neurol Neurosurg","first-page":"92","article-title":"Ventriculocisternostomy versus ventriculoperitoneal shunt in the treatment of hydrocephalus: a retrospective, long-term observational study","volume":"122","author":"Gliemroth","year":"2014"},{"key":"b9-focus16193","series-title":"Neurosurgery","first-page":"109","article-title":"Endoscopic third ventriculostomy in 250 adults with hydrocephalus: patient selection, outcomes, and complications","volume":"78","author":"Grand","year":"2016"},{"key":"b10-focus16193","series-title":"Can J Neurol Sci","first-page":"729","article-title":"Neuropsychological outcome after endoscopic third ventriculostomy","volume":"41","author":"Hader","year":"2014"},{"issue":"1 Suppl 1","key":"b11-focus16193","series-title":"Neurosurgery","first-page":"ONS168","article-title":"Complications of endoscopic third ventriculostomy in previously shunted patients","volume":"63","author":"Hader","year":"2008"},{"key":"b12-focus16193","series-title":"Semin Pediatr Neurol","first-page":"34","article-title":"Treatment of hydrocephalus in adults","volume":"16","author":"Hamilton","year":"2009"},{"key":"b13-focus16193","series-title":"J Neurosurg","first-page":"861","article-title":"The role of endoscopic third ventriculostomy in adult patients with hydrocephalus","volume":"110","author":"Jenkinson","year":"2009"},{"key":"b14-focus16193","series-title":"Malawi Med J","first-page":"78","article-title":"Exit ventriculoperitoneal shunt; enter endoscopic third ventriculostomy (ETV): contemporary views on hydrocephalus and their implications on management","volume":"25","author":"Kamalo","year":"2013"},{"issue":"2 Suppl","key":"b15-focus16193","series-title":"World Neurosurg","first-page":"S22.e1","article-title":"Third ventriculostomy in normal pressure hydrocephalus","volume":"79","author":"Kandasamy","year":"2013"},{"key":"b16-focus16193","series-title":"J Neurosurg Pediatr","first-page":"310","article-title":"Predicting who will benefit from endoscopic third ventriculostomy compared with shunt insertion in childhood hydrocephalus using the ETV Success Score","volume":"6","author":"Kulkarni","year":"2010"},{"key":"b17-focus16193","series-title":"J Neurosurg Pediatr","first-page":"11","article-title":"Quality of life after endoscopic third ventriculostomy and cerebrospinal fluid shunting: an adjusted multivariable analysis in a large cohort","volume":"6","author":"Kulkarni","year":"2010"},{"key":"b18-focus16193","series-title":"J Neurosurg","first-page":"1447","article-title":"Predicting success of endoscopic third ventriculostomy: validation of the ETV Success Score in a mixed population of adult and pediatric patients","volume":"123","author":"Labidi","year":"2015"},{"key":"b19-focus16193","series-title":"Neurochirurgie","first-page":"165","article-title":"Endoscopic 3rd ventriculocisternostomy: procedural complications and long-term dysfunctions?","volume":"59","author":"Melot","year":"2013"},{"key":"b20-focus16193","series-title":"Acta Neurochir Suppl","first-page":"25","article-title":"Ten years of clinical experience in the use of fixed-pressure versus programmable valves: a retrospective study of 159 patients","volume":"113","author":"Mpakopoulou","year":"2012"},{"key":"b21-focus16193","series-title":"J Neurosurg","first-page":"151","article-title":"Laparoscopic versus open insertion of the peritoneal catheter in ventriculoperitoneal shunt placement: review of 810 consecutive cases","volume":"115","author":"Naftel","year":"2011"},{"key":"b22-focus16193","series-title":"J Surg Res","first-page":"140","article-title":"Shunting for hydrocephalus: analysis of techniques and failure 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