Department of Neurological Surgery Columbia University New York, New York, United States
Introduction: Aqueductal stenosis (AS) is a cause of symptomatic hydrocephalus in middle aged to elderly adults, representing ~10% of cases. Clinical presentation commonly overlaps with idiopathic normal pressure hydrocephalus (iNPH), characterized by gait disturbance, cognitive impairment, and urinary incontinence. While endoscopic third ventriculostomy (ETV) is a preferred treatment, patient response can vary. This study evaluates the efficacy of ETV in adult hydrocephalus due to AS and identifies factors influencing the need for follow-up shunt placement.
Methods: We retrospectively analyzed 84 adults with AS who underwent ETV at Columbia University Medical Center between 1999 and 2023. Patient demographics, clinical outcomes, complications and neuroradiographic data were collected. We evaluated patient factors including age, gender, and radiographic parameters, to identify predictors of clinical improvement and the need for shunt placement. Pearson's Chi-squared test, Welch Two Sample t-test, and Fisher's exact test were performed using R.
Results: Of the 84 patients, 62% were male, with a median age of 67. Sixty-two patients were managed with ETV alone. Of 59 with long term follow up, 48 (81%) improved clinically, with gait improvement in 40, cognitive improvement in 11, and headache relief in 9. Twenty-two patients progressed to shunt placement (26%), at a median of 389 days following ETV. Older age at the time of ETV was a significant predictor of progression to shunt (OR = 1.23, p = 0.018). Callosal angle was also a significant predictor, with each degree increase leading to an 8% decrease in the odds of progression to shunt (OR 0.92, p = 0.046). There were no complications from ETV in this adult cohort.
Conclusion : ETV is a safe and effective treatment for adult hydrocephalus caused by aqueductal stenosis. Age and callosal angle are key predictors of the subsequent need for shunt placement.
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