A 6-month-old infant presents with bulging anterior fontanelle, irritability, sunset sign, and rapidly increasing head circumference crossing two centile lines. MRI shows aqueductal stenosis causing triventricular hydrocephalus. The PREFERRED surgical treatment in this case is:

• A Lumbar puncture repeated every 48 hours to reduce CSF pressure
• B Ventriculoperitoneal shunt (VPS) insertion
• C Endoscopic third ventriculostomy (ETV) ✓
• D External ventricular drain as definitive treatment

Explanation

Aqueductal stenosis is the ideal indication for endoscopic third ventriculostomy (ETV), which creates a communication between the floor of the third ventricle and the prepontine cistern, bypassing the obstruction. ETV avoids the hardware-related complications of VP shunts (infection, obstruction, overdrainage, slit-ventricle syndrome) and has durable success rates especially in infants over 6 months with obstructive (non-communicating) hydrocephalus. VP shunt is preferred for communicating hydrocephalus or when ETV is technically not feasible.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.