Outcomes of Endoscopic Third Ventriculostomy (ETV) in Hydrocephalus Secondary to Aqueductal Stenosis after Age of Anterior Fontanel Closure

Background: Non-communicated hydrocephalus secondary to aqueductal stenosis is common, for which endoscopic third ventriculostomy (ETV) has emerged as an effective surgical management. Objective: To evaluate the clinical outcomes of ETV in patients with obstructive hydrocephalus due to aqueductal stenosis in patients over 2 years of age. Methods: This retrospective study was conducted at our institution and included 57 patients older than 2 years who underwent ETV between 2017 and 2024. Demographic data, clinical presentation, and follow-up outcomes were analysed. ETV was considered successful if the patient remained shunt-free during the follow-up period. Results: The mean age was 22.8 ± 10.5 years (range: 2–42 years). Follow-up period was 18.6 ± 4.5 months (range: 12–30 months), ETV was successful in 50 patients (87.7%), while 7 patients eventually required VP shunt. Complications occurred in 11 patients (19.3%), most commonly subcutaneous CSF collections ± leak (5), followed by subdural hygromas (2), transient oculomotor palsy (2), transient mutism (1), and wound infection (1). All were transient or manageable; no permanent neurological deficits or procedure-related mortality were observed. Conclusions:ETV is a safe and effective first-line treatment for aqueductal stenosis related hydrocephalus in patients older than two years, with high long-term success and a favourable safety profile.