Our Experience with The Treatment of Hydrocephalus in Infants: Endoscopic Third Ventriculostomy versus Ventriculo-Peritoneal Shunt: A retrospective Comparative Study

Background: Hydrocephalus is the commonest pediatric neurological disorder and usually treated by cerebrospinal fluid (CSF) diversion. This diversion accomplished by third ventriculostomy or ventriculo-peritoneal shunt. However, the optimal management is still controversial.  Aim of the work: To compare the endoscopic third ventriculostomy (ETV) to ventriculo-peritoneal (VP) shunt in management of Infantile hydrocephalus. Patients and Methods:We conducted a retrospective analysis for 40 infants with hydrocephalus. The treatment used was CSF diversion by ETV or VP shunt. Results: oth treatment groups were comparable regarding age, gender, cause of hydrocephalus, incidence of postoperative re-obstruction, OFC change, hematoma, revision surgery, mortality or success rate. However, the operative time was significantly reduced among ETV when compared to VP shunt group (48.80±9.13 vs 66.75±7.65 minutes, respectively). The rate of postoperative infection was significantly decreased in ETV when compared to VP shunt groups (15.0% vs 45.0% respectively). Finally, the overall mortality during postoperative one year follow up duration was 42.5% with no significant difference between ETV and VP shunt groups (35.0% vs 50.0% respectively). In addition, the overall failure rate was 50.0%, which was lower among ETV when compared to V shunt groups (35.0% vs 65.0% respectively) with no significant difference. Conclusion: Endoscopic third ventriculostomy is effective and safe intervention for treatment of infantile hydrocephalus (for infants between 6 and 3 years of age). It is superior to VP shunt as it is associated with lower postoperative infection and shorter operation time, when compared to shunt.