Outcome of Endoscopic Third Ventriculostomy in Pediatric Patients at Zewditu Memorial Hospital, Ethiopia

Biluts, Hagos; Admasu, Azarias Kassahun

doi:10.1016/j.wneu.2016.04.114

Cited by 16 publications

(10 citation statements)

References 19 publications

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“…8-10. The higher risk of postoperative infection and complications among VPS patients in our study was in agreement with a number of previous studies. 16,18,27 Similar to a study conducted at a teaching hospital in Iraq, 27 age and sex were found to have no association with complication risk, while type of procedure and cause of hydrocephalus were strongly associated with complications-children who underwent shunt surgery and were diagnosed to have myelomeningocele or encephalocele had high complication rates in our study. The majority of patients with myelomeningocele or encephalocele who developed complications were younger than 1 year of age, which is in line with published results 2,26,28,29 for infants and supports the suggestion that these congenital conditions are risk factors for shunt infection and complications.…”

Section: Discussionsupporting

confidence: 81%

“…A recent large retrospective analysis, comparing ETV with VPS placement, reported a significantly higher operative failure rate for ETV at 1 year postsurgery. 25 In contrast, our study demonstrated increased operative failure among children who underwent VPS placement compared to ETV; there are other studies that reported a similar finding, 15,16,18 and this might partly be accounted by an increased infection rate among younger patients who underwent VPS placement surgery.…”

Section: Discussioncontrasting

confidence: 58%

“…CNS infe ction has be e n re porte d as the most common cause of pae diatric hydrocephalus in Uganda 5 ; this differs from Ethiopia, where the leading causes of paediatric hydroce phalus have be e n conge nital malformations (myelomeningocele and encephalocele). 16,17,[19][20][21][22][23] Choosing the best procedure for CSF diversion in paediatric patients is difficult, particularly in very young patients. Recent research has demonstrated that outcome for ETV is a function of age, with younger patients having a lower probability of success.…”

Section: Discussionmentioning

confidence: 99%

“…Recent small studies have shown that ETVs can work in a good pe rce ntage of childre n with communicating hydrocephalus. 15,16 Recently, our department demonstrated a higher success rate among operations performed on patients with obstructive (noncommunicating) hydrocephalus (when the ventricles do not communicate through their foramina or the aqueduct of Sylvius) compared with the nonobstructive (communicating) type (caused by lesions that obstruct the subarachnoid space, wherein there is a free flow of fluid out of the ventricles). 16…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic third ventriculostomy versus ventriculoperitoneal shunt placement in children with obstructive hydrocephalus

Mersha¹

2018

East. Cent. Afr. J. Surg.

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Background: Uncertainty persists on the best treatment for patients with obstructive hydrocephalus: endoscopic third ventriculostomy (ETV) or ventriculoperitoneal shunt (VPS), particularly in the younger age groups. The author investigated and compared 1-year outcomes for ETV and VPS treatment categories at Zewditu Memorial Hospital (ZMH), Ethiopia. Methods: This was a retrospective, hospital-based study. The study reviewed 259 paediatric patients with hydrocephalus in whom VPS or ETV with or without choroid plexus cauterisation (CPC) was done as a primary treatment, between January 2013 and January 2016 at ZMH. Patients' medical records, operative notes, and neural tube database records were used to complete a structured questionnaire. The difference in proportions was examined using the chi-square test. Results: Sixty-seven (25.9%) children initially underwent ETV and 192 (74.1%) underwent VPS placements. The median age was 5 months (range 3 days-168 months). Children who underwent VPS placement rather than ETV had a statistically significant higher risk of postoperative infection (27.0% vs 6.1%; P = 0.001), complications (27.0% vs 12.2%; P = 0.025), and a higher but insignificant operative failure rate at 1 year (45.3% vs 38.8%; P = 0.27). Sex and age were not associated with the occurrence of complications, while VPS and myelomeningocele or encephalocele (MMC/EC) were strongly associated. Complication and infection were significantly and negatively associated with complication-free 1-year survival rate (P < 0.001 each), while gender, age, procedure, and cause of hydrocephalus did not show any association with survival. There was a significant reduction of VPS success rate from 76.9% at 6 months postsurgery to 54.7% at 1 year (P < 0.001), while ETV success rate remained constant during the same period (66.7% and 61.2%, respectively). Mortality frequencies for ETV and VPS insertion were 3 (4.5%) and 9 (4.7%), respectively, for a combined total of 12 deaths (4.6%). Conclusions: Sex and age were not associated with complications, while VPS and MMC/EC were strongly associated. Children who underwent VP shunt placement rather than ETV had a higher risk of postoperative infection and complications, but there was no difference in operative failure or success rate and mortality rates between the procedures. ETV failure rate was less likely after 6 months.

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Section: Discussionsupporting

confidence: 81%

Section: Discussioncontrasting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Endoscopic third ventriculostomy versus ventriculoperitoneal shunt placement in children with obstructive hydrocephalus

Mersha¹

2018

East. Cent. Afr. J. Surg.

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“…21 Prior to this current study, the impact of ETV+CPC patient selection on procedural success had not yet been fully elucidated, with recent publications showing divergent results. 1,2,8,16,[22][23][24] In the North American setting, Stone and Warf published an overall ETV+CPC success rate of 57% and a 65% shunt-free rate in 91 infants with hydrocephalus. 16 Other single-center studies without affiliation with CCHU have reported significantly lower success rates of 37%-42%.…”

mentioning

confidence: 99%

Predictors of success for combined endoscopic third ventriculostomy and choroid plexus cauterization in a North American setting: a Hydrocephalus Clinical Research Network study

Riva-Cambrin

Kestle

Rozzelle

et al. 2019

Journal of Neurosurgery: Pediatrics

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OBJECTIVEEndoscopic third ventriculostomy combined with choroid plexus cauterization (ETV+CPC) has been adopted by many pediatric neurosurgeons as an alternative to placing shunts in infants with hydrocephalus. However, reported success rates have been highly variable, which may be secondary to patient selection, operative technique, and/or surgeon training. The objective of this prospective multicenter cohort study was to identify independent patient selection, operative technique, or surgical training predictors of ETV+CPC success in infants.METHODSThis was a prospective cohort study nested within the Hydrocephalus Clinical Research Network’s (HCRN) Core Data Project (registry). All infants under the age of 2 years who underwent a first ETV+CPC between June 2006 and March 2015 from 8 HCRN centers were included. Each patient had a minimum of 6 months of follow-up unless censored by an ETV+CPC failure. Patient and operative risk factors of failure were examined, as well as formal ETV+CPC training, which was defined as traveling to and working with the experienced surgeons at CURE Children’s Hospital of Uganda. ETV+CPC failure was defined as the need for repeat ETV, shunting, or death.RESULTSThe study contained 191 patients with a primary ETV+CPC conducted by 17 pediatric neurosurgeons within the HCRN. Infants under 6 months corrected age at the time of ETV+CPC represented 79% of the cohort. Myelomeningocele (26%), intraventricular hemorrhage associated with prematurity (24%), and aqueductal stenosis (17%) were the most common etiologies. A total of 115 (60%) of the ETV+CPCs were conducted by surgeons after formal training. Overall, ETV+CPC was successful in 48%, 46%, and 45% of infants at 6 months, 1 year, and 18 months, respectively. Young age (< 1 month) (adjusted hazard ratio [aHR] 1.9, 95% CI 1.0–3.6) and an etiology of post–intraventricular hemorrhage secondary to prematurity (aHR 2.0, 95% CI 1.1–3.6) were the only two independent predictors of ETV+CPC failure. Specific subgroups of ages within etiology categories were identified as having higher ETV+CPC success rates. Although training led to more frequent use of the flexible scope (p < 0.001) and higher rates of complete (> 90%) CPC (p < 0.001), training itself was not independently associated (aHR 1.1, 95% CI 0.7–1.8; p = 0.63) with ETV+CPC success.CONCLUSIONSThis is the largest prospective multicenter North American study to date examining ETV+CPC. Formal ETV+CPC training was not found to be associated with improved procedure outcomes. Specific subgroups of ages within specific hydrocephalus etiologies were identified that may preferentially benefit from ETV+CPC.

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Hydrocephalus in the developing world

Reynolds

Dewan

2023

Cerebrospinal Fluid and Subarachnoid Space

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Outcome of Endoscopic Third Ventriculostomy in Pediatric Patients at Zewditu Memorial Hospital, Ethiopia

Cited by 16 publications

References 19 publications

Endoscopic third ventriculostomy versus ventriculoperitoneal shunt placement in children with obstructive hydrocephalus

Endoscopic third ventriculostomy versus ventriculoperitoneal shunt placement in children with obstructive hydrocephalus

Predictors of success for combined endoscopic third ventriculostomy and choroid plexus cauterization in a North American setting: a Hydrocephalus Clinical Research Network study

Hydrocephalus in the developing world

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