Sait KAYHAN, Abdullah DUMAN, Şahin KIRMIZIGÖZ, Mehmet Can EZGÜ, Yusuf İZCİ
European Journal of Therapeutics - 2026;32(1):106-113
Objective: To compare the clinical outcomes of endoscopic third ventriculostomy (ETV) alone versus single-stage ETV combined with ventriculoperitoneal (VP) shunt placement in pediatric obstructive hydrocephalus, and to determine whether the combined approach reduces early failure in high-risk etiologies without increasing complication rates. Methods: A retrospective cohort of 59 children treated for obstructive hydrocephalus between 2010 and 2024 was analyzed. Patients underwent either ETV alone (n=26) or single-stage ETV with VP shunt placement (n=33). Etiology, demographic characteristics, intraoperative findings, postoperative complications, revision surgeries, and radiological outcomes were systematically recorded. Treatment success was defined as the absence of additional cerebrospinal fluid diversion procedures and sustained clinical-radiological stability during follow-up. Early and late complications, infection rates, and mortality were also evaluated. Statistical analyses included the Student t-test or Mann-Whitney U test for continuous variables and Fisher exact test for categorical variables, with significance set at p<0.05. Results: Aqueductal stenosis was the most common etiology (64.4%), followed by posthemorrhagic obstruction (16.9%), fourth ventricular outlet obstruction (11.9%), and tumor-related obstruction (6.8%). Treatment success was significantly higher in the combined ETV+VP shunt group compared with the ETV-alone group (87.9% vs. 65.4%, p=0.038). Revision surgery was required in 9 ETV patients (34.6%) and 4 combined-procedure patients (12.1%, p=0.038). Early infection rates were identical between groups (2 cases each, p=1.000), and late infection rates did not differ significantly. Overall infection rates (p=0.744) and mortality (4 vs. 3 patients, p=0.696) were comparable between the two approaches. Conclusion: In this cohort, single-stage ETV with VP shunt placement was associated with a higher treatment success rate compared with ETV alone, particularly in infants and children with posthemorrhagic ventricular obstruction. These findings suggest that the combined strategy may help address early physiological limitations of ETV and could be considered a safe and promising option in appropriately selected pediatric patients with obstructive hydrocephalus.
