Endoscopic Third Ventriculostomy versus Ventriculo-Peritoneal Shunt for Infant Hydrocephalus

Objective: To compare the outcome of ventriculo-peritoneal shunt (VP shunt) versus endoscopic third ventriculostomy (ETV) as surgical intervention in management of Infant hydrocephalus. Methodology: A prospective, randomized controlled trial was conducted at the department of Neurosurgery Nishtar University Hospital between June 2023 and November 2023. Study was conducted on 62 pediatric patients with hydrocephalus, all fewer than two years of age, who underwent cerebrospinal fluid (CSF) diversion through either endoscopic third ventriculostomy (ETV) or ventriculoperitoneal (VP) shunt placement. Patients were randomly assigned to one of two treatment groups: ETV or VP shunt. Randomization was done using a computer-generated sequence to ensure unbiased allocation. The ETV group underwent endoscopic surgery to create an opening in the third ventricle to allow CSF to bypass the obstruction. The VP shunt group received a surgically implanted device to divert CSF from the ventricles to the peritoneal cavity. Results: Infection was higher in Group VP than Group ETV as 5 (16.1%) and 1 (3.2%), respectively, (p=0.086). Similarly, obstruction was higher in Group VP than Group ETV as 11 (35.5%) and 9 (29.0%), respectively, (p=0.587). Whereas, surgery was revised 16 (51.6%) in Group VP and 13 (41.9%) in Group Erate TV, (p=0.445). Conclusion: This suggests that ETV presents as a favorable alternative to VP shunt placement due to its reduced risk of postoperative complications and quicker operative duration, while still maintaining comparable efficacy in terms of preventing obstruction, and the necessity for revision surgeries.