Outcome of Endoscopic Third Ventriculostomy (ETV) and Ventriculo-Peritoneal (VP) Shunt in Normal Pressure Hydrocephalus.

Abstract

Objective: Compare twelve-month functional recovery, complication profiles and long-term revision rates between endoscopic third ventriculostomy and ventriculoperitoneal shunting for idiopathic normal pressure hydrocephalus. Study Design: Retrospective Cohort study. Period: January to December 2025. Setting: Department of Neurosurgery, Nishtar Hospital Multan. Methods: Sixty-two adults aged fifty or older with radiologically confirmed ventriculomegaly and positive high-volume tap tests underwent either endoscopic third ventriculostomy or programmable ventriculoperitoneal shunting. Baseline characteristics were rigorously matched. Primary endpoints assessed functional restoration via standardized mobility and cognitive instruments. Secondary metrics evaluated procedure-related adverse events, secondary surgical interventions, hospitalization duration, and validated quality-of-life indices. Multivariate logistic regression and Kaplan-Meier survival analysis controlled for demographic and clinical confounders. Results: Meaningful functional improvement occurred in 77.4% of the endoscopic cohort versus 83.9% in the shunt group, confirming statistical non-inferiority. Gait parameters improved comparably across both interventions. No perioperative mortality was recorded in either cohort. The endoscopic approach demonstrated substantially lower complication frequencies (12.9% versus 48.4%), fewer reoperations (6.5% versus 29.0%), and reduced median hospital stays. Multivariate modeling identified positive tap test responsiveness and preserved cortical architecture as independent predictors of recovery, whereas procedural selection failed to independently influence outcomes. Conclusion: Endoscopic third ventriculostomy provides equivalent functional restoration to mechanical shunting while significantly minimizing hardware-related complications and revision burdens. Preoperative physiological profiling, rather than surgical tradition, must dictate therapeutic strategies in carefully selected candidates.