Predictors of Surgery-Free Outcome in Adult Endoscopic Third Ventriculostomy

Woodworth, Graeme F.; See, Alfred P.; Bettegowda, Chetan; Batra, Sachin; Jallo, George I.; Rigamonti, Daniele

doi:10.1016/j.wneu.2011.09.018

Cited by 23 publications

(21 citation statements)

References 23 publications

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“…Having a prior shunt to ETV portends a 22% relative risk of ETV failure, an outcome that has been reported in other studies. 13,35,36 As noted, the risk of ETV failure tends to occur at a much earlier stage in the primary ETV group, typically within the first 7 months postoperatively, and then plateau, whereas the risk of failure in the secondary group lingers on for a longer duration, as demonstrated on the KaplanMeier actuarial analysis (Fig. 4).…”

Section: Issues Associated With Etv Treatment Failurementioning

confidence: 68%

“…Our ETV success outcomes fall within the range of outcomes that have been previously reported by other centers. 1,13,18,29,33,36 Some of the highest efficacy data were presented by Woodworth et al, who observed immediate improvements in 89% versus 71% of patients who underwent primary and secondary ETV, respectively. 35 In a larger cohort of 129 patients, Jenkinson et al observed success rates of 83% and 67% in primary and secondary ETV groups, respectively.…”

Section: Efficacy Of Etv Treatmentmentioning

confidence: 99%

“…4,8,19 Nevertheless, large population studies that have focused on the role of ETV in only adult hydrocephalus are comparatively lacking except for a few studies, which have only reported limited follow-up durations. 23,26,31,36 The objective of this article is to evaluate the long-term efficacy of ETV in the management of adult hydrocephalus in a large single-center population.…”

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confidence: 99%

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Endoscopic third ventriculostomy for treatment of adult hydrocephalus: long-term follow-up of 163 patients

Isaacs¹,

Bezchlibnyk²,

Yong

et al. 2016

FOC

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OBJECTIVE The efficacy of endoscopic third ventriculostomy (ETV) for the treatment of pediatric hydrocephalus has been extensively reported in the literature. However, ETV-related long-term outcome data are lacking for the adult hydrocephalus population. The objective of the present study was to assess the role of ETV as a primary or secondary treatment for hydrocephalus in adults. METHODS The authors performed a retrospective chart review of all adult patients (age ≥ 18 years) with symptomatic hydrocephalus treated with ETV in Calgary, Canada, over a span of 20 years (1994–2014). Patients were dichotomized into a primary or secondary ETV cohort based on whether ETV was the initial treatment modality for the hydrocephalus or if other CSF diversion procedures had been previously attempted respectively. Primary outcomes were subjective patient-reported clinical improvement within 12 weeks of surgery and the need for any CSF diversion procedures after the initial ETV during the span of the study. Categorical and actuarial data analysis was done to compare the outcomes of the primary versus secondary ETV cohorts. RESULTS A total of 163 adult patients with symptomatic hydrocephalus treated with ETV were identified and followed over an average of 98.6 months (range 0.1–230.4 months). All patients presented with signs of intracranial hypertension or other neurological symptoms. The primary ETV group consisted of 112 patients, and the secondary ETV consisted of 51 patients who presented with failed ventriculoperitoneal (VP) shunts. After the initial ETV procedure, clinical improvement was reported more frequently by patients in the primary cohort (87%) relative to those in the secondary ETV cohort (65%, p = 0.001). Additionally, patients in the primary ETV group required fewer reoperations (p < 0.001), with cumulative ETV survival time favoring this primary ETV cohort over the course of the follow-up period (p < 0.001). Fifteen patients required repeat ETV, with all but one experiencing successful relief of symptoms. Patients in the secondary ETV cohort also had a higher incidence of complications, with one occurring in 8 patients (16%) compared with 2 in the primary ETV group (2%; p = 0.010), although most complications were minor. CONCLUSIONS ETV is an effective long-term treatment for selected adult patients with hydrocephalus. The overall ETV success rate when it was the primary treatment modality for adult hydrocephalus was approximately 87%, and 99% of patients experience symptomatic improvement after 2 ETVs. Patients in whom VP shunt surgery fails prior to an ETV have a 22% relative risk of ETV failure and an almost eightfold complication rate, although mostly minor, when compared with patients who undergo a primary ETV. Most ETV failures occur within the first 7 months of surgery in patients treated with primary ETV, but the time to failure is more prolonged in patients who present with failed previous shunts.

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Section: Issues Associated With Etv Treatment Failurementioning

confidence: 68%

Section: Efficacy Of Etv Treatmentmentioning

confidence: 99%

mentioning

confidence: 99%

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Endoscopic third ventriculostomy for treatment of adult hydrocephalus: long-term follow-up of 163 patients

Isaacs¹,

Bezchlibnyk²,

Yong

et al. 2016

FOC

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“…2,12,19,50,52,67,69 A thicker third ventricle floor has been negatively associated with ETV success, 59 but unfortunately we could not retrospectively analyze this aspect. The presence of cisternal scarring has been negatively associated with success of the first ETV.…”

Section: Intraoperative Findingsmentioning

confidence: 99%

Endoscopic third ventriculostomy and repeat endoscopic third ventriculostomy in pediatric patients: the Dutch experience

Breimer

Dammers

Woerdeman

et al. 2017

Journal of Neurosurgery: Pediatrics

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OBJECTIVEAfter endoscopic third ventriculostomy (ETV), some patients develop recurrent symptoms of hydrocephalus. The optimal treatment for these patients is not clear: repeat ETV (re-ETV) or CSF shunting. The goals of the study were to assess the effectiveness of re-ETV relative to initial ETV in pediatric patients and validate the ETV success score (ETVSS) for re-ETV.METHODSRetrospective data of 624 ETV and 93 re-ETV procedures were collected from 6 neurosurgical centers in the Netherlands (1998–2015). Multivariable Cox proportional hazards modeling was used to provide an adjusted estimate of the hazard ratio for re-ETV failure relative to ETV failure. The correlation coefficient between ETVSS and the chance of re-ETV success was calculated using Kendall’s tau coefficient. Model discrimination was quantified using the c-statistic. The effects of intraoperative findings and management on re-ETV success were also analyzed.RESULTSThe hazard ratio for re-ETV failure relative to ETV failure was 1.23 (95% CI 0.90–1.69; p = 0.20). At 6 months, the success rates for both ETV and re-ETV were 68%. ETVSS was significantly related to the chances of re-ETV success (τ = 0.37; 95% bias corrected and accelerated CI 0.21–0.52; p < 0.001). The c-statistic was 0.74 (95% CI 0.64–0.85). The presence of prepontine arachnoid membranes and use of an external ventricular drain (EVD) were negatively associated with treatment success, with ORs of 4.0 (95% CI 1.5–10.5) and 9.7 (95% CI 3.4–27.8), respectively.CONCLUSIONSRe-ETV seems to be as safe and effective as initial ETV. ETVSS adequately predicts the chance of successful re-ETV. The presence of prepontine arachnoid membranes and the use of EVD negatively influence the chance of success.

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“…Given the different physiology of cranial development, intracranial compliance, and cerebrospinal fluid (CSF) production and absorption, findings from pediatric studies may not be applicable to adults [8–10]. Woodworth et al reported on a single-institution series of 124 adult ETV patients with 55% success [11], while Dusick et al reported on another single-institution series of 108 adult patients with 77% success with shunt independence [10]. …”

Section: Introductionmentioning

confidence: 99%

Outcomes of endoscopic third ventriculostomy in adults

Lam

Harris

Lin

et al. 2016

Journal of Clinical Neuroscience

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Endoscopic third ventriculostomy (ETV) is an alternative to ventriculoperitoneal shunting for treatment of hydrocephalus. Studies have reported favorable outcomes for up to three-quarters of adult patients. We performed the first ETV outcomes study using an administrative claims database, examining current practice for adult patients in the United States. We queried the Truven Health MarketScan® database for Current Procedural Terminology codes corresponding to ETV and ventriculoperitoneal shunt from 2003 to 2011, including patients over 18 years and data from initial and subsequent hospitalizations. ETV failure was defined as any subsequent ETV or shunt procedure. Five hundred twenty-five patients underwent ETV with 6 months’ minimum follow-up. Mean age was 45.9 years (range 18–86 years). Mean follow-up was 2.2 years (SD: 1.6 years, range 0.5–8.4 years). Etiology of hydrocephalus was 21.3% tumor, 9.0% congenital/aqueductal stenosis, 15.8% hemorrhage, and 53.9% others. ETV was successful in 74.7% of patients. Of 133 who failed, 25 had repeat ETV; 108 had shunt placement. Longer length of stay for index surgery was associated with higher risk of failure (HR: 1.03, p = <0.001), as was history of previous shunt (HR: 2.45, p < 0.001). Among patients with repeat surgeries, median time to failure was 25 days. This study represents a longitudinal analysis of nationwide ETV practice over 9 years. Success rate in this large cohort is similar to that published by other single-center retrospective studies. Age and geographic variation may be associated with surgeon choice of ETV or shunt placement after failure of the initial ETV.

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Predictors of Surgery-Free Outcome in Adult Endoscopic Third Ventriculostomy

Cited by 23 publications

References 23 publications

Endoscopic third ventriculostomy for treatment of adult hydrocephalus: long-term follow-up of 163 patients

Endoscopic third ventriculostomy for treatment of adult hydrocephalus: long-term follow-up of 163 patients

Endoscopic third ventriculostomy and repeat endoscopic third ventriculostomy in pediatric patients: the Dutch experience

Outcomes of endoscopic third ventriculostomy in adults

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