Mechanisms of failure after endoscopic third ventriculostomy in young infants

Wagner, W.; Koch, Dorothee

doi:10.3171/ped.2005.103.1.0043

Cited by 78 publications

(77 citation statements)

References 25 publications

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“…4,14 None of the hydrocephalus-related diagnoses in these data had a significant association with ETV success. While some authors reported no correlation of hydrocephalus etiology with ETV outcomes, 3,8,19,21 others have found etiology to be predictive of ETV success. 1,9,10 Etiology of hydrocephalus accounts for up to 33% of the possible points in the aforementioned ETV success score paradigm.…”

Section: Discussionmentioning

confidence: 99%

Pediatric endoscopic third ventriculostomy: a population-based study

Lam

Harris

Rocque

et al. 2014

PED

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Object Endoscopic third ventriculostomy (ETV) is an alternative to ventriculoperitoneal shunting for hydrocephalus treatment. Choice of treatment options raises questions about which patients are likely to benefit from ETV. The authors performed a population-based analysis using an administrative claims database, examining current practice and outcomes for pediatric patients in the US. Methods The authors queried the MarketScan (Truven Health Analytics) database for Current Procedural Terminology codes corresponding to ETV and ventriculoperitoneal shunting from 2003 to 2011; they included patients 19 years or younger and extracted data from initial and subsequent hospitalizations. Hydrocephalus etiology was classified with ICD-9-CM coding. ETV failure was defined as any subsequent ETV or shunt procedure. Results Five hundred one patients underwent ETV. Of these, 46% were female. The mean age was 8.7 ± 6.4 years (± SD). The mean follow-up was 1.9 ± 1.8 years. Etiology of hydrocephalus was primarily tumor (41.7%) and congenital/aqueductal stenosis (24.4%). ETV was successful in 354 patients (71%). The mean time to failure was 109.9 ± 233 days. Of the 147 patients with ETV failure, 35 (24%) underwent repeat ETV and 112 (76%) had shunt placement. Patients in age groups 0 to < 6 months and 6 months to < 1 year had a significantly higher rate of ETV failure than those 10–19 years (HR 2.9, p = 0.05; and HR 2.3, p = 0.001, respectively). History of prior shunt was associated with higher risk of failure (HR 2.5, p < 0.001). There were no significant associations between hydrocephalus etiology and risk of failure. A second wave of failures occurred at 2.5–3.5 years postoperative in tumor and congenital/aqueductal stenosis patients; this was not observed in other etiology groups. Conclusions This study represents a cross-section of nationwide ETV practice over 9 years. ETV success was more likely among children 1 year and older and those with no history of prior shunt.

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Section: Discussionmentioning

confidence: 99%

Pediatric endoscopic third ventriculostomy: a population-based study

Lam

Harris

Rocque

et al. 2014

PED

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“…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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“…This would favor failure of the stoma. A limited CSF absorptive capacity in the first few months could also potentially contribute to this ETV failure [34].…”

Section: Success Rates and Determinants Of Successmentioning

confidence: 99%

“…These studies seem to indicate that neuroendoscopy is a safe approach for the fenestration of suprasellar arachnoid cysts with a high success rate and low likelihood of necessary postprocedural shunting. For infants with large hemispheric arachnoid cysts, the success rate of endoscopic fenestration is less favorable than in older children; therefore, some authors advocate shunting those primarily in light of low endoscopic success rates [34,60]. The author will advocate a neuroendoscopic approach if possible.…”

Section: Arachnoid Cystsmentioning

confidence: 99%

Ventricular endoscopy in the pediatric population: review of indications

et al. 2014

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Introduction Neuroendoscopy has greatly impacted pediatric neurosurgery over the past few decades. Improved optics and microsurgical tools have allowed neuroendoscopes to be used for a multitude of neurosurgical procedures. Discussion In this review article, we present the breadth of intraventricular neuroendoscopic procedures for the treatment of conditions ranging from hydrocephalus and brain tumors to congenital cysts and other pathologies. We critically discuss treatment indications and reported success rates for neuroendoscopic procedures. We also present novel approaches, technical nuances, and variations from recently published literature and as practiced in the authors' institution.

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Mechanisms of failure after endoscopic third ventriculostomy in young infants

Cited by 78 publications

References 25 publications

Pediatric endoscopic third ventriculostomy: a population-based study

Pediatric endoscopic third ventriculostomy: a population-based study

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

Ventricular endoscopy in the pediatric population: review of indications

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