Failure of ETV in patients with the highest ETV success scores

Gianaris, Thomas; Nazar, Ryan; Middlebrook, Emily; Gonda, David; Jea, Andrew; Fulkerson, Daniel H.

doi:10.3171/2016.7.peds1655

Cited by 36 publications

(13 citation statements)

References 28 publications

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“…Although VPS may be considered the historical gold standard for CSF diversion, the high failure rates and potential for infection make this an undesirable option both for patients and physicians. Therefore, the current literature supports the notion that use of ETV has an overall higher success rate, as predicted by ETVSS, than VPS when managing obstructive hydrocephalus from tectal gliomas [8,15]. Regardless of the failure rate in either procedure, CSF diversion still remains the most commonly performed procedure in pediatric patients with tectal gliomas and is an effective management strategy for treatment and symptomatic relief of associated hydrocephalus in these patients.…”

Section: Management Of Hydrocephalussupporting

confidence: 54%

“…While CSF diversion is the most utilized procedure, it is still prone to failure. Despite an ETV success score generally predicting up to 90% ETV success rate, in cases of failure, patients may require a second ETV procedure or may be switched to a shunt [8,15,24]. The reports of failure in these procedures have been variable among the published literature.…”

Section: Management Of Hydrocephalusmentioning

confidence: 99%

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Management strategies for pediatric patients with tectal gliomas: a systematic review

et al. 2021

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Pediatric tectal gliomas generally have a benign clinical course with the majority of these observed radiologically. However, patients often need treatment for obstructive hydrocephalus and occasionally require cytotoxic therapy. Given the lack of level I data, there is a need to further characterize management strategies for these rare tumors. We have therefore performed the first systematic review comparing various management strategies. The literature was systematically searched from January 1, 2000, to July 30, 2020, to identify studies reporting treatment strategies for pediatric tectal gliomas. The systematic review included 355 patients from 14 studies. Abnormal ocular findings—including gaze palsies, papilledema, diplopia, and visual field changes—were a common presentation with between 13.6 and 88.9% of patients experiencing such findings. CSF diversion was the most performed procedure, occurring in 317 patients (89.3%). In individual studies, use of CSF diversion ranged from 73.1 to 100.0%. For management options, 232 patients were radiologically monitored (65.4%), 69 received resection (19.4%), 30 received radiotherapy (8.4%), and 19 received chemotherapy (5.4%). When examining frequencies within individual studies, chemotherapy ranged from 2.5 to 29.6% and radiotherapy ranged from 2.5 to 28.6%. Resection was the most variable treatment option between individual studies, ranging from 2.3 to 100.0%. Most tectal gliomas in the pediatric population can be observed through radiographic surveillance and CSF diversion. Other forms of management (i.e., chemotherapy and radiotherapy) are warranted for more aggressive tumors demonstrating radiological progression. Surgical resection should be reserved for large tumors and/or those that are refractory to other treatment modalities.

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Section: Management Of Hydrocephalussupporting

confidence: 54%

Section: Management Of Hydrocephalusmentioning

confidence: 99%

Management strategies for pediatric patients with tectal gliomas: a systematic review

et al. 2021

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“…According to previous reports, age, etiology, and experience of the surgeon are important factors that determine success and complication rates of ETV [ 9 ]. Higher success rates, reaching 90%, in some studies have been reported in infants with aqueductal stenosis [ 10 – 16 ].…”

Section: Introductionmentioning

confidence: 99%

ETV in infancy and childhood below 2 years of age for treatment of hydrocephalus

et al. 2020

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Purpose Age and etiology play a crucial role in success of endoscopic third ventriculostomy (ETV) as a treatment of obstructive hydrocephalus. Outcome is worse in infants, and controversies still exist whether ETV is superior to shunt placement. We retrospectively analyzed 70 patients below 2 years from 4 different centers treated with ETV and assessed success. Methods Children < 2 years who received an ETV within 1994-2018 were included. Patients were classified according to age and etiology; < 3, 4-12, and 13-24 months, etiologically; aqueductal stenosis, post-hemorrhagic-hydrocephalus (PHH), tumorrelated, fourth ventricle outflow obstruction, with Chiari-type II and following CSF infection. We investigated statistically the predictors for ETV success through computing Kaplan-Meier estimates using patient's follow-up time and time to ETV failure. Results We collected 70 patients. ETV success rate was 41.4%. The highest rate was in tumor-related hydrocephalus and fourth ventricle outlet obstruction (62.5%, 60%) and the lowest rate was in Chiari-type II and following infection (16.7%, 0%). The below 3 months age group showed relatively lower success rate (33.3%) in comparison to older groups which showed similar results (46.4%, 46.6%). Statistically, a previous VP shunt was a predictor for failure (p value < 0.05). Conclusion Factors suggesting a high possibility of failure were age < 3 months and etiology such as Chiari-type II or following infection. Altered CSF dynamics in patients with PHH and underdeveloped arachnoid villi may play a role in ETV failure. We do not recommend ETV as first line in children < 3 months of age or in case of Chiari II or following infection.

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“…Gianaris et al showed 3 factors that may contribute to failure in those with a high ETVSS: preoperative lethargy, preoperative radiological finding of transependymal flow, and postoperative mTVW. 6 We evaluated those 3 factors, but none showed statistical significance (data not shown). That may be due to the small number of subjects, so further larger studies might be needed to confirm those factors.…”

Section: Radiological Parameters Before and After Etvmentioning

confidence: 99%

The long-term outcomes of endoscopic third ventriculostomy in pediatric hydrocephalus, with an emphasis on future intellectual development and shunt dependency

Hong¹,

Hirokawa²,

Usami³

et al. 2019

Journal of Neurosurgery: Pediatrics

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OBJECTIVEThe goal of this study was to clarify the long-term outcome of endoscopic third ventriculostomy (ETV) in pediatric hydrocephalus in light of the ETV Success Score (ETVSS), shunt dependency, and intellectual development.METHODSThe authors retrospectively analyzed pediatric patients with hydrocephalus who underwent ETV between 2002 and 2012 and who were followed for longer than 5 years as a single-center cohort. The data of the patients’ pre- and postoperative status were collected. The relationships between ETVSS and the full-scale IQ as well as shunt dependency were analyzed. The usefulness of ETVSS for repeat ETV and the change of radiological parameters of ventricle size before and after ETV were also analyzed. The success of ETV was defined as no requirement for further CSF diversion procedures.RESULTSFifty ETVs were performed in 40 patients. The average ETVSS was 61 and the success rate at 6 months was 64%. The mean follow-up was 9.9 years (5.2–15.3 years), and the long-term success rate of ETV was 50%. The Kaplan-Meier survival curve continued to show a statistically significant difference among patients with a low, moderate, and high ETVSS, even after 6 months (p = 0.002). After 15 months from the initial ETV, no patients required additional CSF diversion surgery. There was no statistical significance between ETVSS and the long-term full-scale IQ or shunt dependency (p = 0.34 and 0.12, respectively). The radiological improvement in ventricle size was not associated with better future educational outcome.CONCLUSIONSThe ETVSS was correlated with the long-term success rate. After 15 months from the initial ETV, no patients required an additional CSF diversion procedure. The ETVSS was not considered to be correlated with long-term intellectual status.

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Failure of ETV in patients with the highest ETV success scores

Cited by 36 publications

References 28 publications

Management strategies for pediatric patients with tectal gliomas: a systematic review

Management strategies for pediatric patients with tectal gliomas: a systematic review

ETV in infancy and childhood below 2 years of age for treatment of hydrocephalus

The long-term outcomes of endoscopic third ventriculostomy in pediatric hydrocephalus, with an emphasis on future intellectual development and shunt dependency

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