Repeat Third Ventriculostomy

Abstract

The methods of treating hydrocephalus underwent a dramatic evolution in the last few decades. The initial enthusiasm of the neurosurgical community after years of using shunts as the only treatment of all kinds of hydrocephalus faded despite the fact that dozens of studies have been conducted, and hundreds of significant and seemingly panacean solutions were proposed to improve shunt technology. The reality remains that the overall survival of a shunt and the complication rate have changed only slightly in the last 10–20 years. It seems natural that the alternatives to placement of hardware have been long looked for, and the advent of modern neuroendoscopy in the mid-1980s opened a new page in the history of the war against hydrocephalus, which eventually turned into a war against shunts as well. Endoscopic third ventriculostomies (ETV) have instantly become very popular. ETV is a relatively simple technique, establishes a “natural” pathway for CSF flow, and may help to avoid placement of and reliance upon hardware. ETV is generally considered a safe and effective alternative for patients with triventricular hydrocephalus.