OBJECT: Quality of life (QOL) studies comparing treatment with endoscopic third 
ventriculostomy (ETV) and CSF shunting are very limited. The authors compared 
QOL outcomes following these 2 treatments in a large cohort of children with 
hydrocephalus by using multivariable statistical techniques to adjust for 
possible confounder variables.
METHODS: The families of children between 5 and 18 years of age with previously 
treated hydrocephalus at 3 Canadian pediatric neurosurgery centers completed 
measures of QOL: the Hydrocephalus Outcome Questionnaire (HOQ) and the Health 
Utilities Index Mark 3 (HUI3). Medical records and recent brain imaging studies 
were reviewed. A linear regression analysis was performed with the QOL measures 
as the dependent variable. In multivariable analyses, the authors assessed the 
independent effect of initial hydrocephalus treatment (ETV vs shunting) while 
adjusting for the treatment center, current patient age, age at initial 
treatment, etiology of hydrocephalus, total number of days spent in the hospital 
for initial treatment, total number of days spent in the hospital for subsequent 
hydrocephalus complications, functioning ETV at follow-up assessment, frequency 
of seizures, and current ventricle size.
RESULTS: Data from 603 patients were available for analysis. Fifty-eight 
patients had undergone ETV as their primary treatment and 545 had undergone CSF 
shunting. Endoscopic third ventriculostomy patients were slightly younger at the 
follow-up assessment, were older at the first surgery, and spent fewer days in 
the hospital for hydrocephalus complications. Without adjustment for any 
confounders, treatment with ETV was associated with significantly higher HOQ 
physical scores and HUI3 scores. After multivariable adjustment, however, there 
was no significant difference in any outcome measure. A functioning ETV at the 
time of the follow-up assessment was not significant in any model.
CONCLUSIONS: Treatment with either ETV or CSF shunting does not appear to be 
associated with any substantial difference in QOL outcome after adjusting for 
prognostic factors. Further study is needed to definitively determine the 
relative QOL benefit of either procedure, if any.