Endoscopic third ventriculostomy in failed ventriculoperitoneal shunt in pediatric population

Abstract

Introduction: Ventriculoperitoneal (VP) shunt malfunction is common in pediatric age group patients. There is a high complication rate and revision rate of VP shunt. Endoscopic third ventriculostomy (ETV) can alleviate these complications and can act as an effective alternative for the treatment of hydrocephalus in this age group of patients. Materials and Methods: The authors retrospectively reviewed the management and outcome of 36 failed VP shunts in pediatric patients for the treatment of hydrocephalus. The surgeries were performed between November 2010 and January 2016 in a tertiary care hospital. The minimal follow-up period was 3 months. We divided the patients into the following age groups: <1 year (eight infants), 1–10 years (18 children), and 10–18 years (10 children). The success of the procedure was determined by age, sex, type of hydrocephalus, and the number of shunt revisions and malfunction before ETV. Children with different age ( P = 0.839) and sex group did not show any significant data ( P = 0.798). Children with communicating hydrocephalus had a success rate of 52.9% (17 patients), and children with noncommunicating hydrocephalus had a success rate of 84.2% (19 patients). The success rate in children with only one shunt malfunction was 57.1% (21 patients), whereas in 15 children with two or more shunt malfunctions, the success rate of ETV was 86.7%. Conclusions: The authors conclude that ETV is an effective alternative for the treatment of hydrocephalus in children. Age does not present a contraindication for ETV in failed VP shunt.

Neurotechnology Applied to Medicine. Analysis of Patients Undergoing Neuro Endoscopy in Triventricular Obstructive Hydrocephalus

“…Failures can also occur in high protein and fibrinogen concentration cases, as in cases of infection or post-ventricular bleeding. Fukuhara found that preoperative infections are a high-risk factor for third ventriculocisternostomy failure, as only 11.1% of patients with meningitis remained symptom-free after five years of follow-up (Al-Hakim et al, 2019;Choudhary et al, 2020;Gonzalez-Argote, 2022;Mbaye et al, 2020).…”

Endoscopic third ventriculostomy in previously shunt-treated patients

“…Some previous studies have shown a significant effect of age, 5 whereas others have shown no significant effect of age on outcome. 11,18 Similarly, the etiology of hydrocephalus has had a significant effect on outcome in some studies, 15,17 but not in others. 11 One possible explanation for the lack of significance in the present study is the lack of variation in the sample for these two components of the ETVSS.…”

“…Previous studies have also shown an association between a history of multiple shunt revisions and lower likelihood of success of postshunt ETV. 13,15,16 Our analysis of this risk factor was limited to a subset of the overall sample: those patients for whom the details of all previous shunt surgeries were known. However, in that subset we saw no association between number of shunt revisions and postshunt ETV success.…”

“…1,2 There have been numerous previous studies of ETV in children with a history of a CSF shunt (postshunt ETV), reporting success rates from 50% to 80%. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Two review articles also covered this topic, one of which reported ETV success by meta-analysis in 68% of 519 pooled patients. 19,20 However, nearly all of these reports were single-center retrospective reviews, the largest of which included 88 patients.…”