COMPARATIVE OUTCOMES OF VENTRICULOPERITONEAL SHUNT AND ENDOSCOPIC THIRD VENTRICULOSTOMY IN OBSTRUCTIVE HYDROCEPHALUS ASSOCIATED WITH POSTERIOR FOSSA TUMORS

Abstract

Background: Obstructive hydrocephalus is common in children with posterior fossa tumors (70–90%) but less frequent in adults (10–21%). Ventriculoperitoneal shunting (VPS) is effective but carries lifelong risks, while endoscopic third ventriculostomy (ETV) offers a hardware-free alternative. This study compared outcomes of ETV and VPS in such patients.

Methods: In a randomized controlled trial at Mayo Hospital, Lahore, 168 patients with tumor-related hydrocephalus were assigned to ETV (n=84) or VPS (n=84) prior to tumor surgery. Primary outcome was treatment success, defined as no additional CSF diversion within 12 months. Secondary outcomes included complications, reoperations, hospital stay, and Karnofsky Performance Scale (KPS) scores.

Results: Baseline demographics and tumor characteristics were similar between groups. At 12 months, treatment success was achieved in 80% of ETV patients versus 75% with VPS (p=0.42). Hospital stay was shorter in the ETV group (4.2±1.5 days) compared to VPS (6.8±2.0 days; p<0.001). Complication rates were lower with ETV (8% vs. 18%, p=0.11). No shunt-related infections occurred in the ETV group, while VPS patients experienced 4 CSF infections and 6 shunt failures requiring revision. No mortality was observed. KPS scores improved equally in both groups (+18 points; p=0.33).

Conclusion: Both ETV and VPS are effective for managing obstructive hydrocephalus in posterior fossa tumors. However, ETV offers advantages of shorter hospitalization and fewer complications, making it a favorable alternative to shunting in suitable candidates.