Analysis of the success and failure of endoscopic third ventriculostomy in infants less than 1 year of age

Balthasar, Andrea J.R.; Kort, Hanneke de; Cornips, Erwin M. J.; Beuls, E. A. M.; Weber, Jacobiene W.; Vles, Johan S.H.

doi:10.1007/s00381-006-0219-z

Cited by 57 publications

(26 citation statements)

References 18 publications

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“…1,2,4,6,7,9,11,16,18,20 Recently, we used confounder-adjustment techniques (propensity score modeling) to compare the failure rate of ETV versus shunt placement. 13 We found that, once adjusted for confounders, ETV is associated with a higher initial failure rate, but, over time, the failure rate becomes lower than that associated with shunt placement.…”

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confidence: 99%

Predicting who will benefit from endoscopic third ventriculostomy compared with shunt insertion in childhood hydrocephalus using the ETV Success Score

Kulkarni

Drake

Kestle

et al. 2010

PED

222

151

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Object The authors recently developed and internally validated the ETV Success Score (ETVSS)—a simplified means of predicting the 6-month success rate of endoscopic third ventriculostomy (ETV) for a child with hydrocephalus, based on age, etiology of hydrocephalus, and presence of a previous shunt. A high ETVSS predicts a high chance of early ETV success. In this paper, they assess the clinical utility of the ETVSS by determining whether long-term survival outcomes for ETV versus shunt insertion are different within strata of ETVSS (low, moderate, and high scores). Methods A multicenter, international cohort of children (≤ 19 years old) with newly diagnosed hydrocephalus treated with either ETV (489 patients) or shunt insertion (720 patients) was analyzed. The ETVSS was calculated for all patients. Survival analyses with time-dependent modeling of the hazard ratios were performed. Results For the High-ETVSS Group (255 ETV-treated patients, 117 shunt-treated patients), ETV appeared to have a lower risk of failure right from the early postoperative phase and became more favorable with time. For the Moderate-ETVSS Group (172 ETV-treated patients, 245 shunt-treated patients), ETV appeared to have a higher initial failure rate, but after about 3 months the instantaneous risk of ETV failure became slightly lower than shunt failure (that is, the hazard ratio became < 1). For the Low-ETVSS Group (62 ETV-treated patients, 358 shunt-treated patients), the early risk of ETV failure was much higher than the risk of shunt failure, but the instantaneous risk of ETV failure became lower than the risk of shunt failure at about 6 months following surgery (the hazard ratio became < 1). Conclusions Across all ETVSS strata, the risk of ETV failure becomes progressively lower compared with the risk of shunt failure with increasing time from the surgery. In the best ETV candidates (ETVSS ≥ 80), however, the risk of ETV failure is lower than the risk of shunt failure very soon after surgery, while for less-than-ideal ETV candidates (ETVSS ≤ 70), the risk of ETV failure is initially higher than the risk of shunt failure and only becomes lower after 3–6 months from surgery. These results need to be confirmed by larger, prospective, and preferably randomized studies.

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confidence: 99%

Predicting who will benefit from endoscopic third ventriculostomy compared with shunt insertion in childhood hydrocephalus using the ETV Success Score

Kulkarni

Drake

Kestle

et al. 2010

PED

222

151

View full text Add to dashboard Cite

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“…Data from the literature suggest that the clinical response to ETV in adult patients with obstructive hydrocephalus is different from that in children, and the differences are secondary to the age at onset of hydrocephalus, CSF dynamics, and changes in brain viscoelastic properties 8,11,22) . Rates of success reported for ETV in patients 2 years old and younger vary from 0 to 83.3% with a mean of 47.8%, which is significantly lower than the success rate in older children 2,3,6,9,10,[12][13][14]16,[18][19][20][21]24,28,29) . However, when evaluating success rates of secondary ETV, Marton et al 22) reported that age does not have a statistically significant effect, which is also reflected by our data.…”

Section: Discussionmentioning

confidence: 85%

Endoscopic Third Ventriculostomy in Patients with Shunt Malfunction

Lee

Kong

Seol

et al. 2011

J Korean Neurosurg Soc

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Objective : This paper presents data from a retrospective study of endoscopic third ventriculostomy (ETV) in patients with shunt malfunction and proposes a simple and reasonable post-operative protocol that can detect ETV failure. Methods : We enrolled 19 consecutive hydrocephalus patients (11 male and 8 female) who were treated with ETV between April 2001 and July 2010 after failure of previously placed shunts. We evaluated for correlations between the success rate of ETV and the following parameters : age at the time of surgery, etiology of hydrocephalus, number of shunt revisions, interval between the initial diagnosis of hydrocephalus or the last shunt placement and ETV, and the indwelling time of external ventricular drainage. Results : At the time of ETV after shunt failure, 14 of the 19 patients were in the pediatric age group and 5 were adults, with ages ranging from 14 months to 42 years (median age, 12 years). The patients had initially been diagnosed with hydrocephalus between the ages of 1 month 24 days and 32 years (median age, 6 years 3 months). The etiology of hydrocephalus was neoplasm in 7 patients; infection in 5; malformation, such as aqueductal stenosis or megacisterna magna in 3; trauma in 1; and unknown in 3. The overall success rate during the median follow-up duration of 1.4 years (9 days to 8.7 years) after secondary ETV was 68.4%. None of the possible contributing factors for successful ETV, including age (p=0.97) and the etiology of hydrocephalus (p=0.79), were statistically correlated with outcomes in our series. Conclusion : The use of ETV in patients with shunt malfunction resulted in shunt independence in 68.4% of cases. Age, etiology of hydrocephalus, and other contributing factors were not statistically correlated with ETV success. External ventricular drainage management during the immediate post-ETV period is a good means of detecting ETV failure.

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“…Moreover, the authors noted that a second ETV should always be considered before shunt placement in young patients with a failed ETV, as the probability of ETV success rapidly increases 4 months after birth. 53 The largest study of ETV success in very young children was conducted in Uganda and it involved 153 children younger than 1 year. 54 The ETV success rate among these patients was 53%.…”

Section: Discussionmentioning

confidence: 99%

Result of Endoscopic Third Ventriculostomy for Hydrocephalus Caused by Cerebral Aqueductal Stenosis in Infant Patients

Chowdhury

Haque

Kawsar

et al. 2017

IJNS

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Background Endoscopic third ventriculostomy (ETV) is one of the important management options for hydrocephalus, especially obstructive hydrocephalus. The result of ETV in different age and etiology is quite variable according to the different authors. The study was carried out to assess the success rate of ETV as a treatment for this type of hydrocephalus in infant age group. Material and Methods The study was done prospectively on infants (age 12 months) admitted in the period from January 2009 to June 2013 suffering from obstructive hydrocephalus due to cerebral aqueductal stenosis (CAS). After making the diagnosis, we counseled the patient party about the probability of high failure rate of ETV in this age group and probable necessity of a second operation. With the informed consent, we performed ETV in these cases and followed up regularly in postoperative period. Control neuroimaging studies were done whenever needed (suspected failure of ETV and suspected stomal block). Results Total 17 infants were studied. Average follow-up was 18.7 months. Twelve infants were between the age group of six and under six months while five were above six months to one year old. Fourteen (82.35%) out of 17 patients showed overall clinical improvement. Clinical improvement was seen in two (66.6%) infants aged 2 months or younger, three (75%) aged 2 þ to 3 months, five (100%) aged 3 þ to 6 months, and four (80%) aged 6 þ months to 1 year. Two patients had bleeding during surgery. Three developed CSF leak through the burr hole. In one case (the patient's age was 2 months), the stoma was found blocked, and hydrocephalus returned 9 weeks after ETV. In two patients, in whom VP shunt was needed, "failed ETV" was obvious in early postoperative period. In this series, average ETV success score (ETVSS) was 52.35 (range: 40-70) and overall success rate was 82.35%. This indicates that ETVSS does not correlate with the outcome of ETV in infants with CAS. Conclusion Outcome of ETV for hydrocephalus from CAS in infant is quite good and ETVSS does not correlate with the outcome.

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Analysis of the success and failure of endoscopic third ventriculostomy in infants less than 1 year of age

Cited by 57 publications

References 18 publications

Predicting who will benefit from endoscopic third ventriculostomy compared with shunt insertion in childhood hydrocephalus using the ETV Success Score

Predicting who will benefit from endoscopic third ventriculostomy compared with shunt insertion in childhood hydrocephalus using the ETV Success Score

Endoscopic Third Ventriculostomy in Patients with Shunt Malfunction

Result of Endoscopic Third Ventriculostomy for Hydrocephalus Caused by Cerebral Aqueductal Stenosis in Infant Patients

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