PURPOSE: Managing hydrocephalus in infants can be very challenging. The most used permanent hydrocephalus treatment in young patients is a ventriculoperitoneal shunt (VPS) placement. Obstructive hydrocephalus in selected young patients can be treated with endoscopic third ventriculostomy (ETV). However, in infants less than 6 months of age, the outcome of both procedures remains to be bothered with complications, revision surgeries and long-term shunt dependency. This retrospective study analyzes the management of hydrocephalus in 54 very young infants with different etiological causes. METHODS: Data was collected retrospectively from a single center university hospital over a 5-year period (2018-2022). All patients under 3 months of age with progressive ventriculomegaly confirmed by cranial ultrasound (cUS), who required neurosurgical intervention, were eligible for this study. Hydrocephalus was treated with serial tapping from a ventricular access device (VAD), placement of ventriculoperitoneal shunts and/or performing a thulium laser-assisted ETV. RESULTS: Twelve patients benefited sufficiently from a VAD to normalize ventricular volume lastingly. Forty-two patients required permanent treatment (28 underwent a VPS
14 an ETV if there was obstructive hydrocephalus) at an average age of 2.5 months. The VPS failure rate was 32.1% and the ETV failure rate was 50%. Although not significantly different, patients with failed ETV tended to be younger than patients with successful ETV (p = 0.38). One week before permanent ETV treatment, relatively large ventricular volumes were measured in failed ETV patients, as compared to successful ETVs. CONCLUSIONS: Managing hydrocephalus in very young infants remains challenging regarding surgical strategy, reducing shunt dependency and decreasing current complication rates. In addition to a VPS, an ETV has shown to be a successful treatment option for hydrocephalus in well-selected very young infants. The opportunity to decrease ventricular volume with a VAD could have contributed to the success of an ETV in this young patient group.