Successful endoscopic third ventriculostomy in children depends on age and etiology of hydrocephalus: outcome analysis in 51 pediatric patients

Duru, Soner; Peiró, José L.; Oria, Marc; Aydın, Emrah; Subasi, Canan; Tuncer, Cengiz; Rekate, Harold L.

doi:10.1007/s00381-018-3811-0

Cited by 26 publications

(15 citation statements)

References 45 publications

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“…Shunt infection need not be considered a contraindication for ETV even though the success rate might be slightly lower in such cases [24]. Secondary ETV success rates in pediatric case series reported in the literature range from 60 to 80% [14, 16, 25-27] which matches with the success rate of 73.5% in our case series. Marton et al [25] studied 22 children in 2010 who underwent ETV for shunt malfunction and found no significant correlation between ETV failure and patient age or etiology of hydrocephalus.…”

Section: Discussionsupporting

confidence: 77%

“…Marton et al [25] studied 22 children in 2010 who underwent ETV for shunt malfunction and found no significant correlation between ETV failure and patient age or etiology of hydrocephalus. Zhao et al [26] found a history of preterm birth and age <6 months at initial shunt insertion to be a negative predictor of success while Duru et al [27] reported etiology other than isolated aqueductal stenosis to be a negative predictor of success for secondary ETV. Secondary ETV has been found to be effective in close to 100% of cases of following hemorrhagic hydrocephalus as against 61% of cases with primary ETV.…”

Section: Discussionmentioning

confidence: 99%

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Role of Secondary Endoscopic Third Ventriculostomy in Children: Review of an Institutional Experience

et al. 2019

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Background: Endoscopic third ventriculostomy (ETV) has become a standard and safe procedure for obstructive hydrocephalus. ETV can also play an important role in children presenting with shunt malfunction with an added advantage of shunt independence. Secondary ETV can be defined as either a redo endoscopic ventriculostomy done after primary ETV stoma closure or that done in cases presenting with shunt malfunction. Objective: The aim of our study was to evaluate the role of secondary ETV in the pediatric age group patients. Methods: This is a retrospective analysis of 36 children (<18 years) who underwent ETV after shunt malfunction and 4 children with ETV done after previous ETV stoma closure from 2004 until 2018. In all patients, the obstructive pattern suggesting aqueduct outflow obstruction was observed on MRI. Patients were followed up for a mean period of 4.25 years. Results: ETV was considered successful if the patient avoided a shunt insertion later on in their life. Considering this definition, a success rate of 72% was observed with secondary ETV for shunt malfunction whereas a success rate of 75% was observed after primary ETV failure without any major side effects in any of the patients. Conclusion: ETV can be considered a primary treatment modality in children with shunt malfunction and has a good success rate in cases presenting with closure of previously performed ETV stoma.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Role of Secondary Endoscopic Third Ventriculostomy in Children: Review of an Institutional Experience

et al. 2019

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“…Duru et al [20] reported their experience with ETV in 51 children below 16 years of age; they reported an overall success rate of 80% (40/51) for all etiologies and ages. In patients < 6 months of age, the success rate was 56.2% (9/16), while 6-24 months of age was 88.9% (16/18) and > 24 months was 94.1% (16/17).…”

Section: Etv Success In Children Below 2 Years Of Agementioning

confidence: 99%

“…Higher success rates, reaching 90%, in some studies have been reported in infants with aqueductal stenosis [10][11][12][13][14][15][16]. Lower success rates were reported in patients with postinfectious and post-hemorrhagic hydrocephalus (PHH), and also with prior ventriculoperitoneal (VP) shunt failures [13,14,[17][18][19][20]. Infants have a lower success chance according to Kulkarni et al [21] suggested score of ETV success considering the age factor.…”

Section: Introductionmentioning

confidence: 99%

ETV in infancy and childhood below 2 years of age for treatment of hydrocephalus

et al. 2020

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Purpose Age and etiology play a crucial role in success of endoscopic third ventriculostomy (ETV) as a treatment of obstructive hydrocephalus. Outcome is worse in infants, and controversies still exist whether ETV is superior to shunt placement. We retrospectively analyzed 70 patients below 2 years from 4 different centers treated with ETV and assessed success. Methods Children < 2 years who received an ETV within 1994-2018 were included. Patients were classified according to age and etiology; < 3, 4-12, and 13-24 months, etiologically; aqueductal stenosis, post-hemorrhagic-hydrocephalus (PHH), tumorrelated, fourth ventricle outflow obstruction, with Chiari-type II and following CSF infection. We investigated statistically the predictors for ETV success through computing Kaplan-Meier estimates using patient's follow-up time and time to ETV failure. Results We collected 70 patients. ETV success rate was 41.4%. The highest rate was in tumor-related hydrocephalus and fourth ventricle outlet obstruction (62.5%, 60%) and the lowest rate was in Chiari-type II and following infection (16.7%, 0%). The below 3 months age group showed relatively lower success rate (33.3%) in comparison to older groups which showed similar results (46.4%, 46.6%). Statistically, a previous VP shunt was a predictor for failure (p value < 0.05). Conclusion Factors suggesting a high possibility of failure were age < 3 months and etiology such as Chiari-type II or following infection. Altered CSF dynamics in patients with PHH and underdeveloped arachnoid villi may play a role in ETV failure. We do not recommend ETV as first line in children < 3 months of age or in case of Chiari II or following infection.

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“…The specifics of the revisions performed were not included in the database, so whether revisions being shunt insertion, shunt explantation, or re-ETV are unknown. Studies into survival rates have shown better ETV survival in young infants (< 6 months of age) with aquaduct stenosis, and worse survival rates in children with MMC, hemorrhage or infection, and different success rates of re-ETVor shunt placement [24][25][26]. These data, not included in our study, should be reported in future studies to compare success rate of surgery and outcome data of our surgical experience with other databases [19,24].…”

Section: Discussionmentioning

confidence: 90%

Surgical intervention for hydrocephalus in infancy; etiology, age and treatment data in a Dutch cohort

Holwerda

Lindert²,

Buis

et al. 2019

Childs Nerv Syst

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Purpose To gain insight into the patient characteristics of surgically treated hydrocephalus in the Netherlands, we report the first data from the Dutch Quality Registry NeuroSurgery (QNRS) database for infants with hydrocephalus requiring surgical intervention. Methods We used the prospectively gathered database concerning infants ≤ 2 years of age surgically treated for hydrocephalus. We report data from start of registry, concerning etiology, age, and treatment of patients registered. We compared data with the Hydrocephalus Clinical Research Network (HCRN), a multicenter network of pediatric neurosurgical institutions in North America.Results A total of 359 operated infants was registered in the period from 2010 to 2017. A drop in patients registered was seen in 2015, possibly due to revisions of the database. Most infants were operated on between 1 and 6 months of age. Cause of hydrocephalus was predominantly intracranial hemorrhage, followed by congenital causes. The proportion of infants with aqueduct stenosis and myelomeningocele as cause of hydrocephalus stayed relatively stable during this period of registration. Initial shunting was performed in 40% and reservoir/ETV as initial treatment was done in 60%. In both groups, 50% needed revision surgery. Conclusions The first data concerning surgically treated pediatric hydrocephalus from a prospectively collected Dutch register are presented, showing similar results when comparing to the HCRN database.

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Successful endoscopic third ventriculostomy in children depends on age and etiology of hydrocephalus: outcome analysis in 51 pediatric patients

Cited by 26 publications

References 45 publications

Role of Secondary Endoscopic Third Ventriculostomy in Children: Review of an Institutional Experience

Role of Secondary Endoscopic Third Ventriculostomy in Children: Review of an Institutional Experience

ETV in infancy and childhood below 2 years of age for treatment of hydrocephalus

Surgical intervention for hydrocephalus in infancy; etiology, age and treatment data in a Dutch cohort

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