Safety and Efficacy of Endoscopic Third Ventriculostomy for Tumor-induced Hydrocephalus in the Elderly

Introduction: Endoscopic third ventriculostomy (ETV) is frequently used for treating obstructive hydrocephalus caused by brain tumors, offering CSF diversion and tumor biopsy. However, its efficacy in elderly patients remains understudied. This study evaluates the feasibility and safety of ETV in patients >65 years.

Methods: We retrospectively reviewed adult patients undergoing ETV for tumor-related hydrocephalus (2017-2024). Success was defined by symptom improvement and/or avoiding post-procedure shunt placement.

Results: Among 61 patients with tumor-induced hydrocephalus (59.6% male, mean age 53.6 years), 21 elderly patients (>65 years, mean age 73.4 years) underwent ETV. Pre-ETV external ventricular drains were necessary in 23.8% of elderly patients. While 14 elderly patients had ETV alone, others underwent concurrent procedures, including tumor biopsy (28.6%) and foraminoplasty (4.7%). The ETV success rate in the elderly group was 85.7%, with only 3 patients requiring post-ETV VP shunts (mean time to failure: 124.6 days, range 1-371 days). Postoperative complication rate was 4.7%, and the mean ICU stay was 3.3 days. Importantly, compared to younger patients, elderly patients had significantly higher rates of metastatic lesions causing hydrocephalus (52.4% vs 27.5%, p=0.037) and post-ETV stereotactic radiosurgery (47.6% vs 16.2%, p=0.01). Analysis of the entire cohort revealed that infratentorial tumors were associated with a lower likelihood of ETV failure (HR 0.22[0.05-0.88], p=0.032), suggesting a potential prognostic factor for ETV success.

Conclusion : ETV demonstrates safety and efficacy in tumor-induced hydrocephalus elderly patients with, with success rates comparable to younger adults. Key advantages include the opportunity for concurrent tumor biopsy, reducing the need for multiple surgeries and VP shunt placement. Notably, infratentorial lesions emerged as a predictor of better outcomes. These findings offer valuable guidance for patient selection and management in neurosurgical-oncology, particularly for the elderly population. To further refine treatment strategies, future research should focus on developing an age-specific prognostic scoring system, enhancing our ability to predict outcomes.