Endoscopic third ventriculostomy in infants of less than 1�year of age: which factors influence the outcome?

Koch, Dorothee; Wagner, W.

doi:10.1007/s00381-004-0958-7

Cited by 138 publications

(72 citation statements)

References 26 publications

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“…Our study corroborates others in suggesting the addition of CPC does not lead to an increase in complications compared with ETV performed alone in infants, where the reported rate of meningitis is 0%-12.0%, including CSF leak in 0%-8.5%, hemorrhage in 0%-4.3%, and hygroma in 0%-4.7%. 1,10,11,13,14,17,20,34,45 However, the mortality rate of 3.5% in our series is not negligible, and, although similar to that reported by Kulkarni et al (8.3%), 29 it is higher than mortality reported in series of infants undergoing ETV/ CPC in other North American centers (0%), 44 in Uganda (1.0%), and following ETV alone worldwide, where it is closer to 0%. 1,2,10,11,13,14,20,34,45 However, comparison between cohorts of patients undergoing ETV/CPC, ETV, or CSF shunting from different studies and centers is severely lim- ited by differences in the patient populations.…”

Section: Is Etv/cpc Safe?supporting

confidence: 86%

Endoscopic third ventriculostomy and choroid plexus cauterization with a rigid neuroendoscope in infants with hydrocephalus

Weil¹,

Fallah²,

Chamiraju³

et al. 2016

PED

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OBJECT Combining endoscopic third ventriculostomy (ETV) with choroid plexus cauterization (CPC) has been shown to improve the success rate compared with ETV alone in infants (less than 24 months) with hydrocephalus who were treated in developing countries. The authors sought to evaluate the safety and efficacy of this procedure, using a rigid neuroendoscope, in a single North American center, and to assess whether the ETV success score (ETVSS), the CURE Children’s Hospital of Uganda ETVSS (CCHU ETVSS), and other pre- and intraoperative variables could predict success. METHODS The authors performed a retrospective review of consecutive ETV/CPC procedures performed using a rigid neuroendoscope to treat infantile hydrocephalus. The infants underwent the procedure at Miami Children’s Hospital between January 2007 and 2014, with at least one postoperative follow-up. Duration of follow-up or time to failure of ETV/CPC, the primary outcome measure, was documented. A repeat CSF diversion procedure or death was considered as a failure of ETV/CPC. The time to event was measured using a Kaplan-Meier analysis. The authors analyzed ETVSS, CCHU ETVSS, and pre- and intraoperative variables to determine their suitability to predict success. RESULTS Eighty-five patients (45 boys) with a mean age of 4.3 months (range 1 day to 20 months) underwent ETV/CPC. Etiology included intraventricular hemorrhage of prematurity in 44 patients (51.7%), myelomeningocele (MMC) in 7 (8.2%), congenital aqueductal stenosis in 12 (14.1%), congenital communicating hydrocephalus in 6 (7.1%), Dandy-Walker complex in 6 (7.1%), postinfectious hydrocephalus in 5 (5.8%), and other cause in 5 (5.8%). Six procedure-related complications occurred in 5 (5.8%) patients, including 2 hygromas, 1 CSF leak, and 3 infections. There were 3 mortalities in this cohort. ETV/CPC was successful in 42.1%, 37.7%, and 36.8% of patients at 6, 12, and 24 months follow-up, respectively. The median (95% CI) time to ETV/CPC failure was 4.0 months (0.9–7.1 months). In univariate analyses, both the ETVSS (hazard ratio [HR] 1.03; 95% CI 1.01–1.05; p = 0.004) and CCHU ETVSS (HR 1.48; 95% CI 1.04–2.09; p = .028) were predictive of outcome following ETV/CPC. In multivariate analysis, the presence of prepontine scarring was associated with ETV/CPC failure (HR 0.34; 95% CI 0.19–0.63; p < 0.001). Other variables, such as radiological criteria (prepontine interval, prepontine space, aqueductal stenosis, Third Ventricular Morphology Index) and intraoperative findings (ventriculostomy pulsations, extent of CPC), did not predict outcome. CONCLUSIONS ETV/CPC is a feasible alternative to ETV and ventriculoperitoneal shunt in infants with hydrocephalus. Both the ETVSS and CCHU ETVSS predicted success following ETV/CPC in this single-center North American cohort of patients.

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Section: Is Etv/cpc Safe?supporting

confidence: 86%

Endoscopic third ventriculostomy and choroid plexus cauterization with a rigid neuroendoscope in infants with hydrocephalus

Weil¹,

Fallah²,

Chamiraju³

et al. 2016

PED

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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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“…These results correspond to the data reported by other authors. 32 However, Javadpour et al 47 reported ETV success rate of 33% (continued patency during follow-up in 7 of 21 patients) and found that success depended on etiology rather than on patient age. Baldauf et al 38 reported 50% success rate in idiopathic aqueductal stenosis.…”

Section: Discussionmentioning

confidence: 99%

“…4,24,30,31 Determining the best candidates for ETV has been difficult, with conflicting reports on who are the best candidates, particularly regarding the effect of age and etiology. Reports have indicated that outcome is a function of age 23,32,33 independent of age, 1,34 a function of etiology, 1,35-37 or a function of both age and etiology. 38 More recent evidence from larger, and in one case, multicenter series has supported the finding that age is the main determinant of outcome with younger children, particularly neonates, faring worse.…”

Section: Discussionmentioning

confidence: 99%

Result of Endoscopic Third Ventriculostomy for Hydrocephalus Caused by Cerebral Aqueductal Stenosis in Infant Patients

Chowdhury

Haque

Kawsar

et al. 2017

IJNS

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Background Endoscopic third ventriculostomy (ETV) is one of the important management options for hydrocephalus, especially obstructive hydrocephalus. The result of ETV in different age and etiology is quite variable according to the different authors. The study was carried out to assess the success rate of ETV as a treatment for this type of hydrocephalus in infant age group. Material and Methods The study was done prospectively on infants (age 12 months) admitted in the period from January 2009 to June 2013 suffering from obstructive hydrocephalus due to cerebral aqueductal stenosis (CAS). After making the diagnosis, we counseled the patient party about the probability of high failure rate of ETV in this age group and probable necessity of a second operation. With the informed consent, we performed ETV in these cases and followed up regularly in postoperative period. Control neuroimaging studies were done whenever needed (suspected failure of ETV and suspected stomal block). Results Total 17 infants were studied. Average follow-up was 18.7 months. Twelve infants were between the age group of six and under six months while five were above six months to one year old. Fourteen (82.35%) out of 17 patients showed overall clinical improvement. Clinical improvement was seen in two (66.6%) infants aged 2 months or younger, three (75%) aged 2 þ to 3 months, five (100%) aged 3 þ to 6 months, and four (80%) aged 6 þ months to 1 year. Two patients had bleeding during surgery. Three developed CSF leak through the burr hole. In one case (the patient's age was 2 months), the stoma was found blocked, and hydrocephalus returned 9 weeks after ETV. In two patients, in whom VP shunt was needed, "failed ETV" was obvious in early postoperative period. In this series, average ETV success score (ETVSS) was 52.35 (range: 40-70) and overall success rate was 82.35%. This indicates that ETVSS does not correlate with the outcome of ETV in infants with CAS. Conclusion Outcome of ETV for hydrocephalus from CAS in infant is quite good and ETVSS does not correlate with the outcome.

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Endoscopic third ventriculostomy in infants of less than 1�year of age: which factors influence the outcome?

Cited by 138 publications

References 26 publications

Endoscopic third ventriculostomy and choroid plexus cauterization with a rigid neuroendoscope in infants with hydrocephalus

Endoscopic third ventriculostomy and choroid plexus cauterization with a rigid neuroendoscope in infants with hydrocephalus

Endoscopic Third Ventriculostomy in Patients with Shunt Malfunction

Result of Endoscopic Third Ventriculostomy for Hydrocephalus Caused by Cerebral Aqueductal Stenosis in Infant Patients

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