Selecting patients for endoscopic third ventriculostomy

Endoscopic third ventriculostomy has been used for about 70 years in the treatment of hydrocephalus but was generally abandoned with the development of valve-regulated shunts. With improvements in the understanding of the pathophysiology of hydrocephalus and technical equipment improvements for endoscopy, there has been a resurgence of interest in the procedure. Late-onset aqueductal stenosis is the ideal pathologic condition responding to this treatment, but there are multiple other conditions that are potentially responsive to internal bypass. All patients in whom the ventricles expand at the time of shunt failure should be considered as candidates.