Neuroendoscopic surgery in children: does age at intervention influence safety and efficacy? A single-center experience

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>The aim of this study was to review the safety of pediatric intraventricular endoscopy across separate age groups and to determine whether intraventricular endoscopy is associated with an increased risk of complications or reduced efficacy in infants younger than 1 year.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>In this retrospective cohort study, 286 pediatric patients younger than 17 years underwent intraventricular endoscopy at Great Ormond Street Hospital between December 2005 and December 2014. The primary diagnosis, procedure, and complications were recorded.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Neuroendoscopic surgery was performed in 286 pediatric patients (51 neonates 0–6 months [Group 1]; 37 infants 6–12 months [Group 2]; 75 patients 1–5 years [Group 3]; 54 patients 5–10 years [Group 4]; and 69 patients ≥ 10 years [Group 5]; male/female ratio 173:113). The most common procedures included endoscopic third ventriculostomy (ETV) in 159 patients and endoscopic fenestration of intracranial cysts in 64 patients. A total of 348 consecutive neuroendoscopic procedures were undertaken. Nine different complications were identified, of which postoperative seizures (1.7%), CSF leak (3.1%), CSF infection (2.4%), and intracranial hemorrhage (1.7%) were the most common. Specifically, no significant difference in complication rate (11.9%) or infection rate (2.4%) was observed among age groups (p = 0.40 and p = 0.91, respectively). In addition, there were no perioperative deaths; 30-day mortality was 1.1%. After neuroendoscopy for CSF diversion (n = 227), a significantly higher rate of shunt insertion was observed in the youngest group (Group 1, 63.0%) when compared with older groups (Group 2, 46.4%; Group 3, 26.3%; Group 4, 38.6%; and Group 5, 30.8%; p = 0.03). Similarly, for patients who underwent ETV as their initial neuroendoscopic procedure or in combination with additional surgical interventions (n = 171), a significantly higher rate of shunt insertion was also observed within young infants (Group 1, 67.9%; Group 2, 47.6%; Group 3, 19.6%; Group 4, 27.3%; and Group 5, 23.3%; p = 0.003).</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>Intraventricular endoscopy is a safe neurosurgical intervention in pediatric patients of all ages, although it might be associated with increased shunt rates after endoscopic surgery, specifically ETV, in younger infants.</jats:p></jats:sec>

Intracranial Neoplasms in the First Year of Life: Results of a Third Cohort of Patients From a Single Institution

“…Gross total resection was achieved in 29% of the procedures performed directly on brain tumors, a similar figure to that noted in a recent retrospective report 19 . Our series also underlines the increasing use of endoscopy, undertaken in 9 infants, which has been shown to be safe, with low incidence of adverse events, in this patient population 20 . This allowed effective management of hydrocephalus and tumor biopsy (see Figure 2).…”

Endoscopic-assisted Duraplasty with Collagen Matrix for Growing Skull Fracture: A Case Report

“…Endoscopy provides a large and clear visualization of deep lesions and has been increasingly utilized in pediatric neurosurgery, 23) where working space is limited. It was able to assist in identifying the area of dural defect and maneuvering with minimal skin incisions in our case; however, dural defects may extend beyond the skull fracture in some patients, and enlargement of the skin incision may be necessary to visualize the defect.…”

The Role of the Liliequist Membrane in the Third Ventriculostomy

“…ETV success and technical aspects of the TC/LM overture Currently, ETV is widely performed [49,42,41,27,25,20,40,26,7,39]. However, discrepancies in its e cacy can be found throughout the literature [3,7,4,13,25,26,40,42,46]. The technical details of the ETV procedure may vary among providers, although incomplete opening of the TC or LM could also contributed to these discrepancies [22,43].…”

“…Endoscopic third ventriculostomy (ETV) is a procedure to treat hydrocephalus that allows ventricular cerebrospinal uid to be diverted into the subarachnoid cisterns. Despite the e cacy of ETV, discrepancies have been reported in pediatric populations [1,3,4,13,25,26,40,42,46]. These discrepancies are likely caused by the non-observance of technical details.…”