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

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>The 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.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>The 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.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Fifty 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.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>The 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.</jats:p></jats:sec>

Endoscopic third ventriculostomy for the management of hydrocephalus secondary to posterior fossa tumors: A retrospective study

“…documented an association between ETV success score and the long-term success rate, but not with long-term intellectual status; no additional CSF diversion technique was required for all patients at the 15-month follow-up period following initial ETV. [ 12 ]…”

“…[27] Recently, Hong et al documented an association between ETV success score and the long-term success rate, but not with long-term intellectual status; no additional CSF diversion technique was required for all patients at the 15-month follow-up period following initial ETV. [12] Complete resection of PFBT should restore the normal CSF pathway. However, many children would develop uncontrolled persistent hydrocephalus after tumor resection because of the postoperative adhesions related to either the aqueduct or the outlets of the fourth ventricle.…”

Tercerventriculostomía endoscópica del paciente adulto. Resultados tras la aplicación de nuestro protocolo.

“…22 Sobre los resultados de nuestra serie Las tasas de éxito de TVE reportadas en la literatura mundial son muy variables; rondan del 23,1% al 90,9%. 18,[23][24][25][26][27][28][29][30][31][32][33][34][35][36] Esta variabilidad en la tasa de éxito se explica por la diversidad etiológica de la hidrocefalia en cada serie.…”

Recognizing and managing hydrocephalus in children

“…51 The ETV success score (ETVss), developed in 2009 by Kulkarni and colleagues, is widely used to predict the likelihood of success of ETV (Table 2). 52,53 To derive an estimated 6-month probability of ETV success, ETVss uses age, cause, and history of previous shunt placement. Scores are calculated in intervals of 10: a score of 0 to 40 indicates low likelihood of ETV success; 50 to 70 indicates moderate likelihood; and 80 or greater indicates high likelihood of success.…”

“…ETVss53,56 A score of 0 to 40 indicates low likelihood of ETV success; 50 to 70 indicates moderate likelihood; and 80 or greater indicates high likelihood of success.lifelong risk of surgical complications and treatment failure. Clinicians must be familiar with the presentation of newonset hydrocephalus as well as the signs of shunt failure or malfunction and use up-to-date diagnostic modalities to provide an appropriate workup.…”