AIM: To evaluate the outcomes in low-pressure hydrocephalus (LPH) following an endoscopic third ventriculostomy, and placement of a valveless ventriculoperitoneal or ventriculoatrial shunt catheter.

MATERIAL and METHODS: This novel surgical technique was assessed in a prospective case series at a single center between December 2020 and December 2022. Patients were selected for the hybrid procedure based on the Pang?Altschuler diagnostic criteria for LPH. Those with normal or high-pressure hydrocephalus or less than six months of follow-up were excluded. All patients were evaluated clinically (Karnofsky performance status [KPS]) and radiologically (standardized set of images) in the preoperative and postoperative period, and their outcome was categorized as excellent, temporary improvement, or poor.

RESULTS: This case series comprised 16 patients. The mean postoperative improvement in KPS was 56 points. All patients showed improved KPS. All follow-up scans showed radiological improvement. System dysfunction and the need for a shunt with a valve were detected in 18.75% of cases (n=3). The outcome was excellent in 81.25% of cases (n=13), and temporary improvement in 18.75% (n=3).

CONCLUSION: The presented series demonstrated that the hybrid procedure effectively treats LPH and has minimal number of complications.