A Prospective Study on Clinical and Radiological Outcomes of Endoscopic Third Ventriculostomy

Background: Endoscopic third ventriculostomy (ETV) is a well-established alternative to ventriculoperitoneal (VP) shunting for obstructive hydrocephalus. However, its success is influenced by patient age and underlying etiology. Objective: To evaluate the clinical and radiological outcomes of ETV and assess the impact of age and etiology on procedural success. Methods: This prospective analytical study included 30 patients with obstructive hydrocephalus who underwent ETV at a tertiary care centre. Clinical outcomes, intraoperative findings, complications, and radiological features were recorded. ETV success was defined as sustained clinical improvement without the need for VP shunt during follow-up. Results: The mean age was 6.3 ± 4.8 years, with a male predominance (66.7%). Congenital aqueductal stenosis was the most common etiology (50%), followed by tumour-related (26.7%) and post-tubercular meningitic hydrocephalus (23.3%). The overall ETV success rate was 73.3%, with higher success in patients >10 years (85.7%) and tumour-related hydrocephalus (75%). Minor complications, including fever (16.7%), CSF leak (13.3%), and minor bleeding (10%), were managed conservatively. No mortality was reported. The presence of an MRI flow void at the stoma site strongly correlated with successful clinical outcomes. Conclusion: ETV is a safe and effective first-line treatment for obstructive hydrocephalus, providing durable shunt independence with low morbidity. Age and etiology significantly influence success, and clinical recovery, supported by MRI flow-void findings, remains the most reliable indicator of outcome