{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T04:38:58Z","timestamp":1770352738870,"version":"3.49.0"},"reference-count":36,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"12","license":[{"start":{"date-parts":[[2024,3,18]],"date-time":"2024-03-18T00:00:00Z","timestamp":1710720000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,3,18]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Although ventriculoperitoneal shunting is standard for hydrocephalus, shunting may not be ideal for aqueductal stenosis. A cohort of patients with aqueductal stenosis displayed symptoms of over- and underdrainage, despite a patent ventriculoperitoneal shunt (VPS) and optimized valve settings. Endoscopic third ventriculostomies (ETVs) were performed in a subset of these patients with successful treatment of their underlying hydrocephalus, despite a functioning shunt.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>All patients who had undergone ETV with a history of ventriculoperitoneal shunting were retrospectively reviewed. Patients experiencing over- or underdrainage symptoms despite a patent shunt were included. Cerebral aqueduct anatomy and third ventricle bowing were reviewed on preoperative imaging. Seven patients met the study criteria. All showed cerebral aqueductal stenosis and third ventricle bowing. After ETV, all patients demonstrated decreased third ventricle bowing and clinical improvement without the need for secondary cerebrospinal fluid (CSF) diversion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>Despite a functioning VPS, patients with aqueductal stenosis may not be adequately treated. The underlying reasons are not clearly understood but suggest abnormal CSF dynamics due to aberrant parenchymal compliance. The authors theorize that ETV can more effectively treat these patients. ETV can be considered a viable treatment option in aqueductal stenosis despite a patent VPS, challenging the traditional teaching that shunts ideally treat all types of hydrocephalus.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case23295","type":"journal-article","created":{"date-parts":[[2024,3,18]],"date-time":"2024-03-18T15:14:33Z","timestamp":1710774873000},"source":"Crossref","is-referenced-by-count":0,"title":["Endoscopic third ventriculostomy in hydrocephalus patients with functioning ventriculoperitoneal shunts: challenging the dictum that shunts treat all types of hydrocephalus. Patient series"],"prefix":"10.3171","volume":"7","author":[{"given":"Gersham J","family":"Rainone","sequence":"first","affiliation":[{"name":"Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cody","family":"Woodhouse","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dallas","family":"Kramer","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shahed","family":"Elhamdani","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jody","family":"Leonardo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"2","key":"b1","series-title":"Cerebrospinal Fluid Res","first-page":"2","article-title":"The definition and classification of hydrocephalus: a personal recommendation to stimulate debate","volume":"5","author":"Rekate HL","year":"2008","unstructured":"Rekate HL. The definition and classification of hydrocephalus: a personal recommendation to stimulate debate. Cerebrospinal Fluid Res. 2008;5(2):2."},{"issue":"1","key":"b2","series-title":"J Neurosurg Pediatr","first-page":"54","article-title":"The role of endoscopic third ventriculostomy in the treatment of hydrocephalus","volume":"12","author":"Vogel TW","year":"2013","unstructured":"Vogel TW, Bahuleyan B, Robinson S, Cohen AR. The role of endoscopic third ventriculostomy in the treatment of hydrocephalus. J Neurosurg Pediatr. 2013;12(1):54\u201361."},{"issue":"1","key":"b3","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 W","year":"2016","unstructured":"Grand W, Leonardo J, Chamczuk AJ, Korus AJ. Endoscopic third ventriculostomy in 250 adults with hydrocephalus: patient selection, outcomes, and complications. Neurosurgery. 2016;78(1):109\u2013119."},{"issue":"4","key":"b4","series-title":"J Neurosurg Pediatr","first-page":"389","article-title":"Third ventricular shape: a predictor of endoscopic third ventriculostomy success in pediatric patients","volume":"7","author":"Foroughi M","year":"2011","unstructured":"Foroughi M, Wong A, Steinbok P, Singhal A, Sargent MA, Cochrane DD. Third ventricular shape: a predictor of endoscopic third ventriculostomy success in pediatric patients. J Neurosurg Pediatr. 2011;7(4):389\u2013396."},{"key":"b5","series-title":"Clin Neurol Neurosurg","first-page":"16","article-title":"Simplest radiological measurement related to clinical success in endoscopic third ventriculostomy","volume":"152","author":"B\u00f6rcek A\u00d6","year":"2017","unstructured":"B\u00f6rcek A\u00d6, U\u00e7ar M, Karaaslan B. Simplest radiological measurement related to clinical success in endoscopic third ventriculostomy. Clin Neurol Neurosurg. 2017;152:16\u201322."},{"issue":"6","key":"b6","series-title":"Neurosurg Rev","first-page":"1575","article-title":"Prediction of endoscopic third ventriculostomy (ETV) success with preoperative third ventricle floor bowing (TVFB): a supplement to ETV success score","volume":"43","author":"Wang Q","year":"2020","unstructured":"Wang Q, Cheng J, Zhang S, Li Q, Hui X, Ju Y. Prediction of endoscopic third ventriculostomy (ETV) success with preoperative third ventricle floor bowing (TVFB): a supplement to ETV success score. Neurosurg Rev. 2020;43(6):1575\u20131581."},{"issue":"2","key":"b7","series-title":"J Pediatr","first-page":"254","article-title":"Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus","volume":"155","author":"Kulkarni AV","year":"2009","unstructured":"Kulkarni AV, Drake JM, Mallucci CL, Sgouros S, Roth J, Constantini S. Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus. J Pediatr. 2009;155(2):254\u20139.e1."},{"issue":"4","key":"b8","series-title":"Minim Invasive Neurosurg","first-page":"238","article-title":"Outcome prediction of third ventriculostomy: a proposed hydrocephalus grading system","volume":"49","author":"Kehler U","year":"2006","unstructured":"Kehler U, Regelsberger J, Gliemroth J, Westphal M. Outcome prediction of third ventriculostomy: a proposed hydrocephalus grading system. Minim Invasive Neurosurg. 2006;49(4):238\u2013243."},{"key":"b9","series-title":"Surg Neurol Int","first-page":"3","article-title":"Endoscopic third ventriculostomy for shunt malfunction: what to do with the shunt?","volume":"4","author":"Neils DM","year":"2013","unstructured":"Neils DM, Wang H, Lin J. Endoscopic third ventriculostomy for shunt malfunction: what to do with the shunt? Surg Neurol Int. 2013;4:3."},{"issue":"3","key":"b10","series-title":"Childs Nerv Syst","first-page":"157","article-title":"Useful components of the shunt tap test for evaluation of shunt malfunction","volume":"9","author":"Sood S","year":"1993","unstructured":"Sood S, Kim S, Ham SD, Canady AI, Greninger N. Useful components of the shunt tap test for evaluation of shunt malfunction. Childs Nerv Syst. 1993;9(3):157\u2013162."},{"issue":"2","key":"b11","series-title":"J Neurosurg Pediatr","first-page":"182","article-title":"Preoperative third ventricular bowing as a predictor of endoscopic third ventriculostomy success","volume":"9","author":"Dlouhy BJ","year":"2012","unstructured":"Dlouhy BJ, Capuano AW, Madhavan K, Torner JC, Greenlee JD. Preoperative third ventricular bowing as a predictor of endoscopic third ventriculostomy success. 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World J Nucl Med. 2014;13(2):75\u201384."},{"key":"b14","series-title":"J Clin Neurosci","first-page":"63","article-title":"Effect of endoscopic third ventriculostomy on cerebrospinal fluid pressure in the cerebral ventricles","volume":"23","author":"Farnoush A","year":"2016","unstructured":"Farnoush A, Tan K, Juge L, Bilston LE, Cheng S. Effect of endoscopic third ventriculostomy on cerebrospinal fluid pressure in the cerebral ventricles. J Clin Neurosci. 2016;23:63\u201367."},{"issue":"2","key":"b15","series-title":"J Neurosci Rural Pract","first-page":"163","article-title":"Endoscopic third ventriculostomy","volume":"3","author":"Yadav YR","year":"2012","unstructured":"Yadav YR, Parihar V, Pande S, Namdev H, Agarwal M. Endoscopic third ventriculostomy. J Neurosci Rural Pract. 2012;3(2):163\u2013173."},{"issue":"6","key":"b16","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 M","year":"2015","unstructured":"Labidi M, Lavoie P, Lapointe G, . Predicting success of endoscopic third ventriculostomy: validation of the ETV Success Score in a mixed population of adult and pediatric patients. J Neurosurg. 2015;123(6):1447\u20131455."},{"key":"b17","series-title":"World Neurosurg","first-page":"e88","article-title":"Third ventricular floor bowing indicates surgical success in patients undergoing endoscopic third ventriculostomy\u2014systematic review and meta-analysis","volume":"157","author":"Hilman S","year":"2022","unstructured":"Hilman S, Aristiady EB, Santiana L, Dewi DK, Nugraha HG. Third ventricular floor bowing indicates surgical success in patients undergoing endoscopic third ventriculostomy\u2014systematic review and meta-analysis. World Neurosurg. 2022;157:e88\u2013e93."},{"issue":"4","key":"b18","series-title":"J Korean Neurosurg Soc","first-page":"217","article-title":"Endoscopic third ventriculostomy in patients with shunt malfunction","volume":"49","author":"Lee SH","year":"2011","unstructured":"Lee SH, Kong DS, Seol HJ, Shin HJ. Endoscopic third ventriculostomy in patients with shunt malfunction. J Korean Neurosurg Soc. 2011;49(4):217\u2013221."},{"issue":"2","key":"b1","series-title":"Cerebrospinal Fluid Res","first-page":"2","article-title":"The definition and classification of hydrocephalus: a personal recommendation to stimulate debate","volume":"5","author":"Rekate HL","year":"2008","unstructured":"Rekate HL. The definition and classification of hydrocephalus: a personal recommendation to stimulate debate. Cerebrospinal Fluid Res. 2008;5(2):2."},{"issue":"1","key":"b2","series-title":"J Neurosurg Pediatr","first-page":"54","article-title":"The role of endoscopic third ventriculostomy in the treatment of hydrocephalus","volume":"12","author":"Vogel TW","year":"2013","unstructured":"Vogel TW, Bahuleyan B, Robinson S, Cohen AR. The role of endoscopic third ventriculostomy in the treatment of hydrocephalus. J Neurosurg Pediatr. 2013;12(1):54\u201361."},{"issue":"1","key":"b3","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 W","year":"2016","unstructured":"Grand W, Leonardo J, Chamczuk AJ, Korus AJ. Endoscopic third ventriculostomy in 250 adults with hydrocephalus: patient selection, outcomes, and complications. 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Clin Neurol Neurosurg. 2017;152:16\u201322."},{"issue":"6","key":"b6","series-title":"Neurosurg Rev","first-page":"1575","article-title":"Prediction of endoscopic third ventriculostomy (ETV) success with preoperative third ventricle floor bowing (TVFB): a supplement to ETV success score","volume":"43","author":"Wang Q","year":"2020","unstructured":"Wang Q, Cheng J, Zhang S, Li Q, Hui X, Ju Y. Prediction of endoscopic third ventriculostomy (ETV) success with preoperative third ventricle floor bowing (TVFB): a supplement to ETV success score. Neurosurg Rev. 2020;43(6):1575\u20131581."},{"issue":"2","key":"b7","series-title":"J Pediatr","first-page":"254","article-title":"Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus","volume":"155","author":"Kulkarni AV","year":"2009","unstructured":"Kulkarni AV, Drake JM, Mallucci CL, Sgouros S, Roth J, Constantini S. Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus. J Pediatr. 2009;155(2):254\u20139.e1."},{"issue":"4","key":"b8","series-title":"Minim Invasive Neurosurg","first-page":"238","article-title":"Outcome prediction of third ventriculostomy: a proposed hydrocephalus grading system","volume":"49","author":"Kehler U","year":"2006","unstructured":"Kehler U, Regelsberger J, Gliemroth J, Westphal M. Outcome prediction of third ventriculostomy: a proposed hydrocephalus grading system. Minim Invasive Neurosurg. 2006;49(4):238\u2013243."},{"key":"b9","series-title":"Surg Neurol Int","first-page":"3","article-title":"Endoscopic third ventriculostomy for shunt malfunction: what to do with the shunt?","volume":"4","author":"Neils DM","year":"2013","unstructured":"Neils DM, Wang H, Lin J. Endoscopic third ventriculostomy for shunt malfunction: what to do with the shunt? Surg Neurol Int. 2013;4:3."},{"issue":"3","key":"b10","series-title":"Childs Nerv Syst","first-page":"157","article-title":"Useful components of the shunt tap test for evaluation of shunt malfunction","volume":"9","author":"Sood S","year":"1993","unstructured":"Sood S, Kim S, Ham SD, Canady AI, Greninger N. Useful components of the shunt tap test for evaluation of shunt malfunction. Childs Nerv Syst. 1993;9(3):157\u2013162."},{"issue":"2","key":"b11","series-title":"J Neurosurg Pediatr","first-page":"182","article-title":"Preoperative third ventricular bowing as a predictor of endoscopic third ventriculostomy success","volume":"9","author":"Dlouhy BJ","year":"2012","unstructured":"Dlouhy BJ, Capuano AW, Madhavan K, Torner JC, Greenlee JD. Preoperative third ventricular bowing as a predictor of endoscopic third ventriculostomy success. J Neurosurg Pediatr. 2012;9(2):182\u2013190."},{"issue":"10","key":"b12","series-title":"Childs Nerv Syst","first-page":"1621","article-title":"Hydrocephalus in aqueductal stenosis","volume":"27","author":"Cinalli G","year":"2011","unstructured":"Cinalli G, Spennato P, Nastro A, . Hydrocephalus in aqueductal stenosis. Childs Nerv Syst. 2011;27(10):1621\u20131642."},{"issue":"2","key":"b13","series-title":"World J Nucl Med","first-page":"75","article-title":"Assessment lumboperitoneal or ventriculoperitoneal shunt patency by radionuclide technique: a review experience cases","volume":"13","author":"Chiewvit S","year":"2014","unstructured":"Chiewvit S, Nuntaaree S, Kanchaanapiboon P, Chiewvit P. Assessment lumboperitoneal or ventriculoperitoneal shunt patency by radionuclide technique: a review experience cases. World J Nucl Med. 2014;13(2):75\u201384."},{"key":"b14","series-title":"J Clin Neurosci","first-page":"63","article-title":"Effect of endoscopic third ventriculostomy on cerebrospinal fluid pressure in the cerebral ventricles","volume":"23","author":"Farnoush A","year":"2016","unstructured":"Farnoush A, Tan K, Juge L, Bilston LE, Cheng S. Effect of endoscopic third ventriculostomy on cerebrospinal fluid pressure in the cerebral ventricles. J Clin Neurosci. 2016;23:63\u201367."},{"issue":"2","key":"b15","series-title":"J Neurosci Rural Pract","first-page":"163","article-title":"Endoscopic third ventriculostomy","volume":"3","author":"Yadav YR","year":"2012","unstructured":"Yadav YR, Parihar V, Pande S, Namdev H, Agarwal M. Endoscopic third ventriculostomy. J Neurosci Rural Pract. 2012;3(2):163\u2013173."},{"issue":"6","key":"b16","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 M","year":"2015","unstructured":"Labidi M, Lavoie P, Lapointe G, . Predicting success of endoscopic third ventriculostomy: validation of the ETV Success Score in a mixed population of adult and pediatric patients. J Neurosurg. 2015;123(6):1447\u20131455."},{"key":"b17","series-title":"World Neurosurg","first-page":"e88","article-title":"Third ventricular floor bowing indicates surgical success in patients undergoing endoscopic third ventriculostomy\u2014systematic review and meta-analysis","volume":"157","author":"Hilman S","year":"2022","unstructured":"Hilman S, Aristiady EB, Santiana L, Dewi DK, Nugraha HG. Third ventricular floor bowing indicates surgical success in patients undergoing endoscopic third ventriculostomy\u2014systematic review and meta-analysis. World Neurosurg. 2022;157:e88\u2013e93."},{"issue":"4","key":"b18","series-title":"J Korean Neurosurg Soc","first-page":"217","article-title":"Endoscopic third ventriculostomy in patients with shunt malfunction","volume":"49","author":"Lee SH","year":"2011","unstructured":"Lee SH, Kong DS, Seol HJ, Shin HJ. Endoscopic third ventriculostomy in patients with shunt malfunction. 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