Lower rates of symptom recurrence and surgical revision after primary compared with secondary endoscopic third ventriculostomy for obstructive XXXX secondary to @entity1276 in adults.

@entity1 @entity1276
UNASSIGNED: OBJECT Endoscopic third ventriculostomy (ETV) is the treatment of choice for obstructive @entity1276 ; however, the success of ETV in @entity1 who have previously undergone shunt placement remains unclear. The present study analyzed 103 adult @entity1 with @entity1276 who underwent ETV for obstructive @entity1276 and evaluated the effect of previous shunt placement on post-ETV outcomes. METHODS This study was a retrospective review of 151 consecutive @entity1 who were treated between 2007 and 2013 with ETV for @entity1276 . One hundred three (68.2%) @entity1 with @entity1276 causing obstructive @entity1276 were included in the analysis. Postoperative ETV patency and aqueductal and cisternal flow were assessed by high-resolution, gradient-echo MRI. Post-ETV Mini-Mental State Examination, Timed Up and Go, and Tinetti scores were compared with preoperative values. Univariate and multivariate analyses were performed comparing the post-ETV outcomes in @entity1 who underwent a primary (no previous shunt) ETV (n = 64) versus secondary (previous shunt) ETV (n = 39). RESULTS The majority of @entity1 showed significant improvement in symptoms after ETV; however, no significant differences were seen in any of the quantitative tests performed during follow-up. Symptom recurrence occurred in 29 (28.2%) @entity1 after ETV, after a median of 3.0 (interquartile range 0.8-8.0) months post-ETV failure. Twenty-seven (26.2%) @entity1 required surgical revision after their initial ETV. @entity1 who received a secondary ETV had higher rates of symptom recurrence (p = 0.003) and surgical revision (p = 0.003), particularly in regard to additional shunt placement/revision post-ETV (p = 0.005). These differences remained significant after multivariate analysis for both symptom recurrence (p = 0.030) and surgical revision (p = 0.043). CONCLUSIONS @entity1 with obstructive @entity1276 due to @entity1276 exhibit symptomatic improvement after ETV, with a relatively low failure rate. @entity1 with a primary history of shunt placement who undergo ETV as a secondary intervention are at increased risk of symptom recurrence and need for surgical revision post-ETV.
