Effectiveness of endoscopic third ventriculostomy in improving cognition and gait in adults with chronic obstructive hydrocephalus: a cohort study.

OBJECTIVE: Endoscopic third ventriculostomy (ETV) is increasingly becoming the preferred treatment for adult chronic obstructive hydrocephalus (COH). However, there is limited evidence on how ETV affects cognitive and gait outcomes, both in the short and long term, in this population. This study was conducted to evaluate the effects of ETV on cognitive functions and gait in adults with COH. METHODS: The authors retrospectively reviewed patients from their center who underwent ETV as the primary treatment for COH. Cognitive testing using the Montreal Cognitive Assessment (MoCA) and Symbol Digit Modalities Test was conducted before ETV and at 3 months and 1 year postoperatively. Gait velocity was measured using a 10-m walk test before ETV, and again at 3 months and 1 year post-ETV. RESULTS: Ninety patients were included in our analysis. The average patient age was 55.4 (SD 13.5) years, and 47.8% (n = 43) of patients were female. Baseline MoCA scores averaged 23.1 (SD 3.1), improving to 25.7 (SD 2.6) at 3 months and 25.8 (SD 3.3) at 1 year (p < 0.001). The increase in MoCA score of 2.7 points met the minimal clinically important difference. Half of the patients had normal MoCA scores after ETV. Gait velocity significantly increased at 3 months and 1 year after ETV (p < 0.001), with mean gait velocity rising from 1.17 (SD 0.49) m/sec to 1.42 (SD 0.43) m/sec at 1 year. The 0.25 m/sec increase in gait velocity was clinically meaningful. With a few exceptions, the literature review found that most studies reported small patient groups, varied diagnoses, and inconsistent or missing reporting metrics. CONCLUSIONS: Cognition and gait improved at 3 months and were sustained 12 months after ETV in adult patients with COH. These findings provide additional evidence that ETV is an effective surgical choice for this patient group. The authors recommend using standardized, objective methods to evaluate etiology-specific ETV outcomes in adults.