Long-term outcome for endoscopic third ventriculostomy alone or in combination with choroid plexus cauterization for congenital aqueductal stenosis in African infants

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The authors have previously reported on the overall improved efficacy of endoscopic third ventriculostomy (ETV) combined with choroid plexus cauterization (CPC) for infants younger than 1 year of age. In the present study they specifically examined the long-term efficacy of ETV with or without CPC in 35 infants with congenital aqueduct stenosis treated at CURE Children's Hospital of Uganda during the years 2001–2006.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Infants with congenital aqueductal stenosis were treated during 2 distinct treatment epochs: all underwent ETV alone, and subsequently all underwent ETV-CPC. Prospectively collected data in the clinical database were reviewed for all infants with an age &lt; 1 year who had been treated for hydrocephalus due to congenital aqueductal stenosis. Study exclusion criteria included: 1) a history or findings on imaging or at the time of ventriculoscopy that suggested a possible infectious cause of the hydrocephalus, including scarred choroid plexus; 2) an open aqueduct or an aqueduct obstructed by a membrane or cyst rather than by stenosis; 3) severe malformations of the cerebral hemispheres including hydranencephaly, significant segments of undeveloped brain, or schizencephaly; 4) myelomeningocele, encephalocele, Dandy-Walker complex, or tumor; or 5) previous shunt insertion. The time to treatment failure was analyzed using the Kaplan-Meier method to construct survival curves. Log-rank (Mantel-Cox) and Gehan-Breslow-Wilcoxon tests were used to determine whether differences between the 2 treatment groups were significant.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Thirty-five patients met the study criteria. Endoscopic third ventriculostomy alone was performed in 12 patients (mean age 4.7 months), and combined ETV-CPC was performed in 23 patients (mean age 3.5 months). For patients without treatment failure, the mean and median follow-ups were, respectively, 51.6 and 48.0 months in the ETV group and 31.2 and 26.4 months in the ETV-CPC group. Treatment was successful in 48.6% of the patients who underwent ETV alone, as accurately predicted by the Endoscopic Third Ventriculostomy Success Score (ETVSS), and in 81.9% of the patients who underwent ETV-CPC (p = 0.0119, log-rank test; p = 0.0041, Gehan-Breslow-Wilcoxon test; HR 6.42 [95% CI 1.51–27.36]).</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Combined ETV-CPC is significantly superior to ETV alone for infants younger than 1 year of age with congenital aqueductal stenosis. The fact that the outcome for ETV alone was accurately predicted by the ETVSS suggests that these results are applicable in developed countries.</jats:p></jats:sec>

Comparative effectiveness of flexible versus rigid neuroendoscopy for endoscopic third ventriculostomy and choroid plexus cauterization: a propensity score–matched cohort and survival analysis

“…Both types of neuroendoscopes are used across centers in North America for ETV/CPC, with reported 12-month success rates ranging from 38% for rigid neuroendoscopy 20 to 57% for flexible neuroendoscopy. 8 In Africa, Asia, and Europe, both flexible neuroendoscopy 1,5,9,10,14,15,19 and rigid neuroendoscopy 2 have been used, with no consensus on the superiority of either technique. A retrospective review of ETV/CPC treatment outcomes from multiple North American centers participating in the Hydrocephalus Clinical Research Network suggested that greater extent of CPC and the use of a flexible neuroendoscope were associated with improved success, although the sample size was small and the patients were not randomized to neuroendoscopy type.…”

Neuroendoscopy Sway in the Treatment of Posterior Fossa Tumours associated Hydrocephalus in Children

“…ETV resulted in satisfactory posterior fossa surgical conditions. ETV has been shown to offer an acceptable low cost alternative treatment to shunts especially in children with obstructive hydrocephalus in developing countries [20,21]. There are numerous studies now confirming the high success rate and low complication rate of ETV.…”

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

“…The study by Warf et al proved the difference in the success rate with 48.6% in patients in whom they practiced only ETV compared to 81.9% in those in whom they practiced ETV and plexus coagulation both. 51 Kulkarni et al 52 reported the relative higher risk of initial failure in ETV than shunt in children. The relative risk becomes progressively lower for ETV after about 3 months.…”