Comparative analysis of outcomes: Endoscopic third ventriculostomy versus ventriculoperitoneal shunt in pediatric obstructive hydrocephalus.

Abstract

Objective: To compare outcomes of hospital stay, infection rates, reoperation rates and success rates in pediatric patients between ETV and VPS. Study Design: Quasi-experimental study. Setting: Lady Reading Hospital, Pakistan. Period: 17 September 2025 to 17 March 2026. Methods: A total of 226 patients (aged 1 month to 16 years) with obstructive hydrocephalus participated in the study. Clinical judgement was used to divide patients into the ETV (n=113) and VPS (n=113) groups. 3 months after surgery, such parameters as hospital stay (days), infection (surgical site or CSF), re-operation rate and success rate (clinical and radiological improvement without revision) were recorded. Multivariable logistic regression identified factors that predicted unfavorable outcomes. T-tests, chi-square tests, and 95% confidence intervals (CIs) were used for comparative analyses. Results: Mean hospital stay in the ETV group (3.1 ± 1.2 days) was significantly shorter than that of VPS (6.9 ± 1.4 days; p<0.001, mean difference 3.8 days, 95% CI 35 to 35-1). Infection rates were lower in ETV (4.4%, 5/113) versus VPS (13.3%, 15/113; p=-0.018, OR 0.30, 95% CI 0.10-0.89). Re-operation rate was 8.8% (10/113) in ETV but 22.1% (25/113) in VPS (p=0.005, OR 0.34, 95% CI 0.15-0.75). Success rate was higher with ETV (70.8%, 80/113) than with VPS (50.4%, 57/113; p < 0.001, OR 2.42, 95% CI 1.46-4.02). In multivariable regression, VPS (OR 3.12, 95% CI 1.72-5.66, p<0.001) and young age (<1 year; OR 2.45, 95% CI 1.28-4.69, p=0.007) were both independent of re-operation. Stratified analysis confirmed that, despite the age and social standing of a child s parents, the benefits from ETV were consistent (p < 0.05 on all primary outcomes). Conclusion: Among children with obstructive hydrocephalus who underwent VPS, ETV achieved a better outcome, with shorter hospital stays, fewer infections and reoperations, a greater success rate. However, given that the study is non-randomized, it should be interpreted cautiously. These findings support ETV as the preferred option in LMICs, suggesting the need to develop better training procedures and allocate resources more rationally to address all surrounding complications with shunt placement.