Success of endoscopic third ventriculostomy in children less than 2 years of age

Etüş, Volkan; Ceylan, Savaş

doi:10.1007/s10143-005-0407-4

Cited by 63 publications

(39 citation statements)

References 30 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

224

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

224

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: 84%

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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“…Historically, endoscopic third ventriculostomy (ETV) always seemed to be a promising technique and can be considered nowadays a standard procedure for obstructive hydrocephalus 6,7 . However, data published in the medical literature is both extensive and conflicting when they come to the role of patients' age and etiology of the hydrocephalus in the success rate (SR) of endoscopic procedures 6,[8][9][10][11][12][13][14][15][16][17][18] . In this study, we present the results of neuroendoscopic operations performed in children during the past ten years in the same institution.…”

mentioning

confidence: 99%

Neuroendoscopic surgery in children: an analysis of 200 consecutive procedures

Furlanetti

Santos

Oliveira

2013

Arq. Neuro-Psiquiatr.

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Objective: Neuroendoscopic surgery in children has particular features and is associated with different success rates (SR). The aim of this study was to identify putative factors that could influence the outcome in pediatric patients. Methods: Clinical data of 177 patients under 18 years of age submitted to 200 consecutive neuroendoscopic procedures from January 2000 to January 2010 were reviewed. Results: The overall success rate was 77%. Out of the patients with successful outcomes, 46% were under six months, 68% were between six months and one year of age, and 85% older than one year. Neuroendoscopic techniques provide very good results for a wide number of indications in children. Tumor-related cerebrospinal fluid (CSF) circulation problems and aqueductal stenosis seem to be particularly well suited to neuroendoscopic treatment regardless of the patient's age. Conclusion: Patients' age and etiology of hydrocephalus were associated with a different outcome. In all cases, surgical experience is extremely important to reduce complications.Key words: endoscopic third ventriculostomy, hydrocephalus, neuroendoscopy, pediatric neurosurgery. RESUMOObjetivo: A cirurgia neuroendoscópica em crianças apresenta particularidades e está associada a diferentes taxas de sucesso (TS). O objetivo deste estudo consistiu em identificar fatores que pudessem influir no resultado do tratamento em pacientes pediátricos. Métodos: Dados clíni-cos de 177 pacientes com idade inferior a 18 anos submetidos a 200 procedimentos neuroendoscópicos consecutivos entre janeiro de 2000 e janeiro de 2010 foram revisados. Resultados: A taxa de sucesso global foi de 77%. Os pacientes com idade inferior a seis meses apresentaram taxa de sucesso de 46%; pacientes entre seis meses e um ano de vida obtiveram êxito em 68% dos casos; dentre os maiores de um ano, 85% dos procedimentos foram bem-sucedidos. Técnicas neuroendoscópicas proporcionam muito bons resultados para uma grande variedade de indicações em crianças. Independentemente da faixa etária, o tratamento endoscópico apresenta-se particularmente adequado para problemas da circulação liquórica relacionados a tumores e à estenose aquedutal. Conclusão: A faixa etária dos pacientes e a etiologia da hidrocefalia estão associadas a diferentes resultados. Em todos os casos, experiência neurocirúrgica é extremamente importante para a redução das complicações.Palavras-Chave: terceiro ventriculostomia endoscópica, hidrocefalia, neuroendoscopia, neurocirurgia pediátrica.

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Success of endoscopic third ventriculostomy in children less than 2 years of age

Cited by 63 publications

References 30 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

Neuroendoscopic surgery in children: an analysis of 200 consecutive procedures

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