Endoscopic third ventriculostomy for obstructive hydrocephalus in children younger than 6 months of age: is it a first-choice method?

Lipina, Radim; Reguli, Štefan; Doležilová, Viera; Kunčíková, Marie; Podešvová, Hana

doi:10.1007/s00381-008-0616-6

Cited by 42 publications

(26 citation statements)

References 35 publications

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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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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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“…ETV success rates in infants are generally lower than those in adults and vary between 31 and 64% [4,8,18,34,36,38,52,56]. While many authors, including us, believe that ETV success is mainly dependent on etiology and therefore recommend this procedure in most children with OHC regardless of age [4,8,13,34,36,37,38,56], others have shown that success in infants depends on both age and etiology [18,52,54], and some have even suggested that age is the primary determinant of outcome regardless of etiology in pediatric patients [26,53]. To explain their findings, these authors proposed that infant brain, meninges, and cranium cannot tolerate the persistent elevated intracranial pressure that occurs after ETV or their absorptive system is immature [26].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Third Ventriculostomy: The Lebanese Experience

Rahme

Rahme²,

Hourani³

et al. 2009

Pediatr Neurosurg

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Background: Endoscopic third ventriculostomy (ETV) has gained wide popularity as a first-line treatment for obstructive hydrocephalus (OHC). We have been performing ETV since 1998. We report our experience with this technique in the management of OHC. Methods: Between 1998 and 2007, we performed 49 ETV procedures in 46 patients suffering from OHC. Medical records were retrospectively reviewed. Success was defined as shunt-free survival. Results: There were 29 males and 17 females with a mean age of 23 years (6 months–65 years). Aqueductal stenosis and tectal tumor were the most common etiologies (63%). Seven patients (15.6%) had early ETV failure. Of 38 patients with initial success and available follow-up, shunt independence was achieved in 29 patients (76.3%) after a mean follow-up of 37 months. Kaplan-Meier analysis yielded a 70% 5-year shunt-free survival rate. On multivariate analysis, no variables could predict early or late ETV failure. Transient complications occurred in 6 patients (13%), but there were no ETV-related deaths or permanent morbidity. Conclusion: ETV is a safe and effective treatment for OHC, resulting in a high rate of long-term shunt independence with a low risk of complications. ETV should be considered the treatment of choice for patients with OHC and its development as a substitute to shunt placement should be encouraged in neurosurgically developing countries.

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“…Recent reports have shown good outcomes with ETV in early infancy. 5,6 The child was clinically well over the following 6 months. No imaging was done in the follow-up period due to financial constraints.…”

Section: Discussionmentioning

confidence: 93%