Pediatric Obstructive Hydrocephalus: Comparative Outcomes of Endoscopic Third Ventriculostomy Alone Versus Single-Stage Endoscopic Third Ventriculostomy with Ventriculoperitoneal Shunt Placement

Objective: To compare the clinical outcomes of endoscopic third ventriculostomy (ETV) alone versus single-stage ETV combined with ventriculoperitoneal (VP) shunt placement in pediatric obstructive hydrocephalus, and to determine whether the combined approach reduces early failure in high-risk etiologies without increasing complication rates. Methods: A retrospective cohort of 59 children treated for obstructive hydrocephalus between 2010 and 2024 was analyzed. Patients underwent either ETV alone (n=26) or single-stage ETV with VP shunt placement (n=33). Etiology, demographic characteristics, intraoperative findings, postoperative complications, revision surgeries, and radiological outcomes were systematically recorded. Treatment success was defined as the absence of additional cerebrospinal fluid diversion procedures and sustained clinical-radiological stability during follow-up. Early and late complications, infection rates, and mortality were also evaluated. Statistical analyses included the Student t-test or Mann-Whitney U test for continuous variables and Fisher exact test for categorical variables, with significance set at p