# Complications and risk factors of endoscopic third ventriculostomy: A 10-year single-centre study and systematic literature review

## TL;DR

This study reviews the success and complication rates of endoscopic third ventriculostomy for hydrocephalus and compares results from a single hospital to global data.

## Contribution

The paper provides updated benchmarks for ETV outcomes and identifies risk factors for failure.

## Key findings

- Previous shunting and neurosurgery are risk factors for ETV failure.
- The study found a higher success rate and complication rate in their patient cohort compared to the literature.
- Results from the systematic review can help neurosurgical centers perform internal audits.

## Abstract

Endoscopic third ventriculostomy is considered a safe and low-risk treatment of obstructive hydrocephalus. No systematic review has been conducted recently to establish benchmarks for success and complication rates. This knowledge gap makes it difficult to evaluate local institutional performance against international results.

What are the results of endoscopic third ventriculostomy for obstructive hydrocephalus in the literature, and how does it compare to the results of our medium-sized neurosurgical center?

We performed a retrospective case series of patients treated at the Department of Neurosurgery, Haukeland University Hospital, from January 1, 2013, to December 31, 2023. A systematic review was performed in accordance with the PRISMA guidelines.

Our case series consisted of 127 patients in a mixed-age cohort (mean: 37.3, range: 0–86) treated with endoscopic third ventriculostomy for hydrocephalus the last ten years. Previous shunting and neurosurgery were identified as risk factors for endoscopic third ventriculoscopy failure. In our systematic review, we found 64 reports with a total of 8409 patients eligible for inclusion. A higher success rate (78.7%) and complication rate (21.3%) were found in our patient material compared to the findings in our systematic review (respectively 73.4% and 11.6%). All complications in our material were transient and did not cause any permanent morbidity.

Endoscopic third ventriculostomy has a favorable safety profile with high success rates in the treatment of obstructive hydrocephalus. Results from our systematic review can be used for internal audits at other neurosurgical centers.

•This is the second literature review on endoscopic third ventriculostomy (ETV) for hydrocephalus since 2011.•Results from our medium-sized neurosurgical center are comparable to what is reported previously in the literature.•We found a mean success rate of 73.4% (1%–64%) and complication rate of 11.6% (41%–95%) in our systematic review.•Previous neurosurgery and previous shunting was identified as risk factors for ETV-failure of endoscopic third ventriculostomy in our series.•Results from our systematic review provide neurosurgical centers with information for internal audits.

This is the second literature review on endoscopic third ventriculostomy (ETV) for hydrocephalus since 2011.

Results from our medium-sized neurosurgical center are comparable to what is reported previously in the literature.

We found a mean success rate of 73.4% (1%–64%) and complication rate of 11.6% (41%–95%) in our systematic review.

Previous neurosurgery and previous shunting was identified as risk factors for ETV-failure of endoscopic third ventriculostomy in our series.

Results from our systematic review provide neurosurgical centers with information for internal audits.