ORIGINAL PAPER Stented endoscopic third ventriculostomy—indications and results Matthias Schulz 1 & Birgit Spors 2 & Ulrich-Wilhelm Thomale 1,3 Received: 19 April 2015 /Accepted: 5 June 2015 # Springer-Verlag Berlin Heidelberg 2015 Abstract Objective In patients with risk of reclosure of a performed opening in the floor of the third ventricle, a stented endoscopic third ventriculostomy (sETV) was performed to maintain con- tinuous cerebrospinal fluid (CSF) diversion in patients with occlusive hydrocephalus. A retrospective analysis of a patient series is presented. Methods A cohort of nine patients (median age 12 years and 9 months; range 1 month to 25 years and 9 months) was studied retrospectively. Etiology of hydrocephalus was aque- duct stenosis due to tumorous occlusion and tumorous infil- tration of the third ventricular floor in seven of nine patients. For two patients with simple aqueductal stenosis, a sETV was performed because of young age of 1 month in one and be- cause of previous ETV failure in the other. Results Correct placement of the implanted stent was demon- strated in all treated patients. There was no operative morbid- ity after the performed sETV. Resolution or improvement of symptoms was achieved in eight of nine patients (88.9 %), and failure to control clinical symptoms was observed in one pa- tient (11.1 %), who needed subsequent shunt insertion. De- creased ventricular dimensions were seen after the sETV pro- cedure. The median fronto-occipital horn ratio (FOHR) decreased from 0.46 (range 0.43–0.58) to 0.45 (range 0.37 to 0.59) after a median of 3 months and to a median of 0.40 (range 0.30 to 0.50) after 17 months. The median fronto- occipital horn width ratio FOHWR decreased from 0.31 (range 0.22 to 0.52) to 0.28 (range 0.14 to 0.52, p =0.06) after a median of 3 months and to a median of 0.21 (range 0.09 to 0.36, p <0.05). Conclusion sETV is a feasible and safe alternative procedure which when performed with an appropriate trajectory allows treatment of occlusive hydrocephalus with altered anatomy of the third ventricular floor. sETV has been demonstrated to resolve or improve clinical and radiological signs of disturbed CSF circulation. Keywords Occlusive hydrocephalus . Endoscopic third ventriculostomy . Stent Introduction Endoscopic third ventriculostomy (ETV) is an established procedure in the treatment of occlusive hydrocephalus. In fact, it is now the preferred method in selected clinical situation such as aqueductal stenosis or obstruction due to posterior fossa tumors. However, there are situations where ETV is known to fail to provide long-standing cerebrospinal fluid (CSF) diversion around the obstructed CSF pathways of the posterior fossa. In some situation—e.g., a thick floor of the third ventricular floor—ETV is deemed to be unsuitable either due to the inability to assess the underlying anatomy or due to concerns about reclosure of the obtained stoma. Apart from the reocclusion of the achieved opening in the floor of the third ventricle, development of new arachnoid proliferations has been noted to be a further mechanism for ETV failure [35]. Likewise, spontaneous closure of endoscopically * Ulrich-Wilhelm Thomale uthomale@charite.de 1 Division of Pediatric Neurosurgery, Charité Universitätsmedizin, Berlin, Germany 2 Department of Pediatric Radiology, Charité Universtätsmedizin, Berlin, Germany 3 Arbeitsbereich Pädiatrische Neurochirurgie, Charité Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, D-13353 Berlin, Germany Childs Nerv Syst DOI 10.1007/s00381-015-2787-2