Endoscopic Third Ventriculostomy versus Ventriculo-Peritoneal Shunt for Infant Hydrocephalus

Abstract

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.

Endoscopic third ventriculostomy in children: problems and surgical outcome: analysis of 34 cases

“…Some authors described ETV failure as the shunt placement requirement. According to Kadrian et al, there is a strong effect of patient age on outcome [ 21 ]. They recorded extremely low reliability of ETV in infants younger than 1 month.…”

Our Experience with the Treatment of Hydrocephalus in infants: Endoscopic Third Ventriculostomy versus Ventriculo-Peritoneal Shunt: A retrospective comparative study

“…However, another meta-analysis demonstrated that, ETV had lower overall complication rate, infection, and revision surgery, shorter operative time and hospital stay duration but were comparable as regard to rate of symptom improvement, hematoma, and mortality when compared to VP shunt [18] . Finally, Abdel-Aziz et al [19] concluded that, ETV is superior than VPS as it is associated with lower rate of postoperative infection, shorter duration of operation. But they could not discover statistical difference regard PO obstruction, need for revision surgery or overall survival.…”