Endoscopic third ventriculostomy in the management of obstructive hydrocephalus caused by aqueductal stenosis.

Long-term extracranial shunting for hydrocephalus has numerous drawbacks related to shunt malfunction and infection. The outcomes have been very disappointing in some cases. We have treated twenty one patients with obstructive hydrocephalus, without mortality or morbidity, using a flexible endocope to perform third ventriculostomy. Favorable outcomes were achieved in 95.2% of the cases. Our results are superior to those previously reported. Most of the patients remained shunt independent after treatment and had obtained long-term stabilization. Flexible endoneurosurgical management is simple and safe, and it allows in situ observation and performance of biopsies. Therefore, in patients with obstructive hydrocephalus due to aqueductal stenosis, endoscopic third ventriculostomy should be seriously considered as the primary surgical management.