DIFFERENTIAL SURGICAL STRATEGY IN OBSTRUCTIVE HYDROCEPHALUS: EVALUATION OF THE CLINICAL EFFECTIVENESS OF ENDOSCOPIC THIRD VENTRICULOSTOMY AND VENTRICULOPERITONEAL SHUNTING.

Abstract.

Obstructive hydrocephalus caused by brain tumors or stenosis of the cerebral aqueduct remains a significant challenge in neurosurgical practice. The choice between endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunting (VPS) continues to be a subject of clinical debate. The aim of this study was to evaluate the effectiveness of an etiology-based differentiated surgical strategy in terms of clinical outcomes and postoperative complications.

Methods: A retrospective analysis was conducted on 23 patients who underwent surgical treatment for obstructive hydrocephalus at the Republican Specialized Scientific and Practical Medical Center of Neurosurgery between September 2024 and December 2025. Patients were divided into two groups according to the surgical procedure performed: the endoscopic third ventriculostomy (ETV) group (n = 8) and the ventriculoperitoneal shunting (VPS) group (n = 15). The choice of surgical technique was based on the etiology of hydrocephalus and neuroimaging findings, with ETV being the preferred approach in cases of tumor-related obstructive hydrocephalus. Treatment efficacy was assessed based on clinical improvement in neurological status and changes in the Evans index measured on postoperative MRI and CT scans.

Results: The overall treatment success rate achieved with the differentiated surgical approach was 78.3%. Shunt dysfunction (obstruction) was observed in 13.3% of patients in the VPS group, whereas no such complication occurred in the ETV group. Postoperative cerebrospinal fluid (CSF) leakage developed in 13.0% of patients and was successfully managed in all cases using conservative and minimally invasive treatment methods. The mean length of hospital stay was 8 days in the ETV group and 10 days in the VPS group, indicating an advantage of ETV in reducing hospitalization time.

Conclusion: An etiology-based differentiated surgical strategy demonstrated high effectiveness in the treatment of obstructive hydrocephalus. ETV appears to be a physiologically preferable and safer treatment option for tumor-related obstructions and aqueductal stenosis, eliminating shunt-related mechanical failures and long-term shunt dependency. Ventriculoperitoneal shunting remains a reliable alternative when ETV is technically unfeasible.