Endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunt (VPS) in non-communicating hydrocephalus (NCH): comparison of outcome profiles in Nigerian children

Uche, Enoch Ogbonnaya; Okorie, Chukwuemeka; Iloabachie, Izuchukwu; Amuta, Dubem S; Uche, NJ

doi:10.1007/s00381-018-3848-0

Cited by 25 publications

(21 citation statements)

References 24 publications

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“…NPH is classically defined as a communicating form of hydrocephalus 37 , 73 - 75 without a fully effective non-invasive treatment. 22 , 76 - 80 However, because of the new hydrodynamic concept of hydrocephalus, 81 , 82 as opposed to the classical dichotomy proposed by Dandy, 82 , 83 the use of endoscopic third ventriculostomy (ETV), which is the golden standard for non-communicating cases, 84 has been reported in selected cases of NPH, as an attempt to restore normal intracranial compliance and pulsatility, normalizing the CSF dynamics. 81 , 82 , 85 - 88 The results showed an effectiveness rate of ETV ranging from 21% to 72%.…”

Section: Idiopathic Normal-pressure Hydrocephalus (Inph)mentioning

confidence: 99%

Normal-pressure hydrocephalus: A critical review

Oliveira

Nitrini

Román

2019

Dement. neuropsychol.

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ABSTRACT. Normal-pressure hydrocephalus (NPH) is a potentially reversible syndrome characterized by enlarged cerebral ventricles (ventriculomegaly), cognitive impairment, gait apraxia and urinary incontinence. A critical review of the concept, pathophysiology, diagnosis, and treatment of both idiopathic and secondary NPH was conducted. We searched Medline and PubMed databases from January 2012 to December 2018 using the keywords “normal-pressure hydrocephalus” / “idiopathic normal-pressure hydrocephalus” / “secondary normal-pressure hydrocephalus” / “NPH” / “ventriculoperitoneal shunt”. The initial search produced 341 hits. After careful selection, a total of 54 articles were chosen and additional relevant studies were included during the process of writing this article. NPH is an important cause of potentially reversible dementia, frequent falls and recurrent urinary infections in the elderly. The clinical and imaging features of NPH may be incomplete or nonspecific, posing a diagnostic challenge for medical doctors and often requiring expert assessment to minimize unsuccessful surgical treatments. Recent advances resulting from the use of non-invasive MRI methods for quantifying cerebral blood flow, in particular arterial spin-labeling (ASL), and the frequent association of NPH and obstructive sleep apnea (OSA), offer new avenues to understand and treat NPH.

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Section: Idiopathic Normal-pressure Hydrocephalus (Inph)mentioning

confidence: 99%

Normal-pressure hydrocephalus: A critical review

Oliveira

Nitrini

Román

2019

Dement. neuropsychol.

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“…25 Studies abroad, including a Nigerian prospective study by Uche et al, have demonstrated higher complication (9%-15%) and reoperation (20%) rates after CSF shunt insertion than those after ETV (4%-8% and 4%, respectively). 26 In the first multiinstitutional prospective study comparing CSF shunt insertion and ETV, IIHS investigators demonstrated greater success rates with CSF shunt insertion (83% at 12 months, 79% at 24 and 36 months) as opposed to ETV (66% at 12 months, 64% at 24 and 36 months). 3 These comparison studies help with the decision between treatment strategies for permanent CSF diversion but incorporate narrow sets of outcome measures.…”

Section: Discussionmentioning

confidence: 99%

Surgical resource utilization after initial treatment of infant hydrocephalus: comparing ETV, early experience of ETV with choroid plexus cauterization, and shunt insertion in the Hydrocephalus Clinical Research Network

Pindrik

Riva-Cambrin

Kulkarni

et al. 2020

Journal of Neurosurgery: Pediatrics

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OBJECTIVEFew studies have addressed surgical resource utilization—surgical revisions and associated hospital admission days—following shunt insertion or endoscopic third ventriculostomy (ETV) with or without choroid plexus cauterization (CPC) for CSF diversion in hydrocephalus. Study members of the Hydrocephalus Clinical Research Network (HCRN) investigated differences in surgical resource utilization between CSF diversion strategies in hydrocephalus in infants.METHODSPatients up to corrected age 24 months undergoing initial definitive treatment of hydrocephalus were reviewed from the prospectively maintained HCRN Core Data Project (Hydrocephalus Registry). Postoperative courses (at 1, 3, and 5 years) were studied for hydrocephalus-related surgeries (primary outcome) and hospital admission days related to surgical revision (secondary outcome). Data were summarized using descriptive statistics and compared using negative binomial regression, controlling for age, hydrocephalus etiology, and HCRN center. The study population was organized into 3 groups (ETV alone, ETV with CPC, and CSF shunt insertion) during the 1st postoperative year and 2 groups (ETV alone and CSF shunt insertion) during subsequent years due to limited long-term follow-up data.RESULTSAmong 1090 patients, the majority underwent CSF shunt insertion (CSF shunt, 83.5%; ETV with CPC, 10.0%; and ETV alone, 6.5%). Patients undergoing ETV with CPC had a higher mean number of revision surgeries (1.2 ± 1.6) than those undergoing ETV alone (0.6 ± 0.8) or CSF shunt insertion (0.7 ± 1.3) over the 1st year after surgery (p = 0.005). At long-term follow-up, patients undergoing ETV alone experienced a nonsignificant lower mean number of revision surgeries (0.7 ± 0.9 at 3 years and 0.8 ± 1.3 at 5 years) than those undergoing CSF shunt insertion (1.1 ± 1.9 at 3 years and 1.4 ± 2.6 at 5 years) and exhibited a lower mean number of hospital admission days related to revision surgery (3.8 ± 10.3 vs 9.9 ± 27.0, p = 0.042).CONCLUSIONSAmong initial treatment strategies for hydrocephalus, ETV with CPC yielded a higher surgical revision rate within 1 year after surgery. Patients undergoing ETV alone exhibited a nonsignificant lower mean number of surgical revisions than CSF shunt insertion at 3 and 5 years postoperatively. Additionally, the ETV-alone cohort demonstrated significantly fewer hospital admission days related to surgical management of hydrocephalus within 3 years after surgery. These findings suggest a time-dependent benefit of ETV over CSF shunt insertion regarding surgical resource utilization.

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“…The difference in both meta-analyses may be due to sample size as Jiang included 2017 patients while Saekhu included 1513 besides differences in reported outcomes in both studies. Uche EO 2018 conducted prospective cohort compared between ETV and VP shunt in children with non-communicating hydrocephalus and showed VPS is associated with an earlier milestone and OFC response while ETV is associated with lower rates of sepsis and mortality [13]. Systematic review by Dewan MC 2017 concerned with children with hydrocephalus following posterior fossa tumor resection showed ETV has long-term treatment durability and sooner failure rate but was associated with lower incidence of complications compared to VP shunt [14].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Third Ventriculostomy versus Ventriculo-Peritoneal Shunt for Infant Hydrocephalus

Abdel-Aziz¹,

Nouby²,

Thabet³

et al. 2020

OJMN

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Introduction: Patients with hydrocephalus, which is the most pediatric neurological disorder, undergo Cerebrospinal fluid (CSF) diversion through third ventriculostomy or ventriculo-peritoneal shunt. Up to date, the optimal hydrocephalus treatment modality is not clear. Aim: We compared the outcome of endoscopic third ventriculostomy (ETV) versus ventriculo-peritoneal shunt (VP shunt) as a second surgical intervention in management of Infant hydrocephalus concerning success rate and complications. Patients and Methods: We conducted an observational study of 52 children with hydrocephalus (congenital or acquired) in whom CSF diversion was performed using either ETV or VP shunt in randomized control trial. Results: During the period examined, 52 children, 26 underwent ETV and 26 underwent VP shunt. The mean age was 11.0 ± 4.3 months in ETV and 11.3 ± 4.7 months in VP shunt. Postoperative infection in the ETV group was lower than in the VP shunt group (23.1% vs. 53.8% P = 0.045). Regarding operating time, In ETV group operation duration was 46.9 min and 64.3 min in the V-P shunt group (P = 0.13). There was no statistically significant difference between the two study groups regarding the rate of obstruction, change in occipital frontal circumference (OFC) or the need of revision surgery. One year survival for VP shunt group vs. ETV group was 46.2% vs. 65.4% respectively. Conclusion: ETV associated with lower rates of postoperative infection and shorter operation time with no significant difference in rates of obstruction, change in OFC and revision surgery in comparison to VP shunt.

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Endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunt (VPS) in non-communicating hydrocephalus (NCH): comparison of outcome profiles in Nigerian children

Abstract: VPS compared to ETV is associated with an earlier milestone and OFC response. ETV is associated with lower rates of sepsis and mortality.

Cited by 25 publications

References 24 publications

Normal-pressure hydrocephalus: A critical review

Normal-pressure hydrocephalus: A critical review

Surgical resource utilization after initial treatment of infant hydrocephalus: comparing ETV, early experience of ETV with choroid plexus cauterization, and shunt insertion in the Hydrocephalus Clinical Research Network

Endoscopic Third Ventriculostomy versus Ventriculo-Peritoneal Shunt for Infant Hydrocephalus

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