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<p>Hydrocephalus is a common neurosurgical condition in the paediatric population characterized by abnormal accumulation of cerebrospinal fluid (CSF) within the ventricular system. It results from impaired CSF circulation, absorption, or excessive production and can lead to progressive ventricular dilation and increased intracranial pressure. Historically, ventriculoperitoneal (VP) shunting has been the primary treatment modality; however, shunt systems are associated with high failure rates, infection, and lifelong dependency. Endoscopic third ventriculostomy (ETV) has emerged as an alternative surgical procedure that restores physiological CSF circulation by creating a stoma in the floor of the third ventricle, allowing CSF diversion into the basal cisterns.</p><p>This narrative review aims to summarize the current literature regarding the indications, surgical technique, success predictors, outcomes, and complications of ETV in children. A comprehensive literature search was performed using PubMed, Scopus, and Google Scholar databases for studies published between 2000 and 2025. Keywords included “endoscopic third ventriculostomy,” “paediatric hydrocephalus,” and “ETV success score.” Studies involving paediatric patients (&lt; 18 years) including cohort studies, clinical trials, and systematic reviews were included, while adult studies and case reports were excluded.</p><p>Available evidence suggests that ETV is particularly effective in obstructive hydrocephalus, especially in cases of aqueductal stenosis and tumor-related obstruction. Reported success rates range between 50% and 80%, depending on patient age, aetiology, and prior shunt placement. The ETV Success Score has been widely adopted as a predictive tool for estimating procedural success. With advances in neuroendoscopic technology and improved patient selection, ETV has become an important treatment option in paediatric hydrocephalus. Future developments including ETV combined with choroid plexus cauterization and AI-assisted imaging may further enhance outcomes.</p>

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Beyond shunt dependency: endoscopic third ventriculostomy in the contemporary management of paediatric hydrocephalus: a narrative literature review

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月9日

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  • Greeshma Suresh,
  • Sarita Chowdhary,
  • Arun B R,
  • Umang Kumar Agrawal,
  • R V Vaishnav Krishna

摘要

Hydrocephalus is a common neurosurgical condition in the paediatric population characterized by abnormal accumulation of cerebrospinal fluid (CSF) within the ventricular system. It results from impaired CSF circulation, absorption, or excessive production and can lead to progressive ventricular dilation and increased intracranial pressure. Historically, ventriculoperitoneal (VP) shunting has been the primary treatment modality; however, shunt systems are associated with high failure rates, infection, and lifelong dependency. Endoscopic third ventriculostomy (ETV) has emerged as an alternative surgical procedure that restores physiological CSF circulation by creating a stoma in the floor of the third ventricle, allowing CSF diversion into the basal cisterns.

This narrative review aims to summarize the current literature regarding the indications, surgical technique, success predictors, outcomes, and complications of ETV in children. A comprehensive literature search was performed using PubMed, Scopus, and Google Scholar databases for studies published between 2000 and 2025. Keywords included “endoscopic third ventriculostomy,” “paediatric hydrocephalus,” and “ETV success score.” Studies involving paediatric patients (< 18 years) including cohort studies, clinical trials, and systematic reviews were included, while adult studies and case reports were excluded.

Available evidence suggests that ETV is particularly effective in obstructive hydrocephalus, especially in cases of aqueductal stenosis and tumor-related obstruction. Reported success rates range between 50% and 80%, depending on patient age, aetiology, and prior shunt placement. The ETV Success Score has been widely adopted as a predictive tool for estimating procedural success. With advances in neuroendoscopic technology and improved patient selection, ETV has become an important treatment option in paediatric hydrocephalus. Future developments including ETV combined with choroid plexus cauterization and AI-assisted imaging may further enhance outcomes.