Ventricular volume and neurocognitive outcome after endoscopic third ventriculostomy: is shunting a better option? A review

Azab, Waleed A.; Mijalcic, Radovan M.; Nakhi, Saleh Ben; Mohammad, Mohammad H.

doi:10.1007/s00381-016-3032-3

Cited by 17 publications

(11 citation statements)

References 38 publications

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“…1 and 2). The latter observation is in keeping with other studies where shunting has been more reliable at decreasing ventricular size than ETV [12,13]. The addition of choroid plexus cauterization (CPC) to ETV adds the potential of reducing CSF production; but its true effect and outcomes remain understudied.…”

Section: Discussionsupporting

confidence: 78%

“…While shunting more reliably decreases ventricular size in hydrocephalic patients than ETV, we are still trying to understand the neurocognitive implications of ventricular size during childhood development [12]. The primary analysis of the IIHS suggested long term overall health status and quality of life for the cohort was, in general, high and that there was no difference between those treated initially with ETV and shunt [7].…”

Section: Discussionmentioning

confidence: 99%

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Cranial and ventricular size following shunting or endoscopic third ventriculostomy (ETV) in infants with aqueductal stenosis: further insights from the International Infant Hydrocephalus Study (IIHS)

et al. 2020

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Purpose The craniometrics of head circumference (HC) and ventricular size are part of the clinical assessment of infants with hydrocephalus and are often utilized in conjunction with other clinical and radiological parameters to determine the success of treatment. We aimed to assess the effect of endoscopic third ventriculostomy (ETV) and shunting on craniometric measurements during the follow-up of a cohort of infants with symptomatic triventricular hydrocephalus secondary to aqueductal stenosis. Methods We performed a post hoc analysis of data from the International Infant Hydrocephalus Study (IIHS)-a prospective, multicenter study of infants (< 24 months old) with hydrocephalus from aqueductal stenosis who were treated with either an ETV or shunt. During various stages of a 5-year follow-up period, the following craniometrics were measured: HC, HC centile, HC zscore, and frontal-occipital horn ratio (FOR). Data were compared in an analysis of covariance, adjusting for baseline variables including age at surgery and sex. Results Of 158 enrolled patients, 115 underwent an ETV, while 43 received a shunt. Both procedures led to improvements in the mean HC centile position and z-score, a trend which continued until the 5-year assessment point. A similar trend was noted for FOR which was measured at 12 months and 3 years following initial treatment. Although the values were consistently higher for ETV compared with shunt, the differences in HC value, centile, and z-score were not significant. ETV was associated with a significantly higher FOR compared with shunting at 12 months (0.52 vs 0.44; p = 0.002) and 3 years (0.46 vs 0.38; p = 0.03) of follow-up.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Cranial and ventricular size following shunting or endoscopic third ventriculostomy (ETV) in infants with aqueductal stenosis: further insights from the International Infant Hydrocephalus Study (IIHS)

et al. 2020

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“…There was no significant difference in the quality of life or neurocognition between ETV and shunting in the past studies. 1,11,13,17 Hader et al compared pre-and post-ETV intelligence scores to find that ETV was helpful in improving cognition. 8 Also, several reports in the litera-ture suggest that ETV is worth trying before shunting even in those younger than 6 months.…”

Section: Etvss and Future Educational Statusmentioning

confidence: 99%

The long-term outcomes of endoscopic third ventriculostomy in pediatric hydrocephalus, with an emphasis on future intellectual development and shunt dependency

Hong¹,

Hirokawa²,

Usami³

et al. 2019

Journal of Neurosurgery: Pediatrics

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OBJECTIVEThe goal of this study was to clarify the long-term outcome of endoscopic third ventriculostomy (ETV) in pediatric hydrocephalus in light of the ETV Success Score (ETVSS), shunt dependency, and intellectual development.METHODSThe authors retrospectively analyzed pediatric patients with hydrocephalus who underwent ETV between 2002 and 2012 and who were followed for longer than 5 years as a single-center cohort. The data of the patients’ pre- and postoperative status were collected. The relationships between ETVSS and the full-scale IQ as well as shunt dependency were analyzed. The usefulness of ETVSS for repeat ETV and the change of radiological parameters of ventricle size before and after ETV were also analyzed. The success of ETV was defined as no requirement for further CSF diversion procedures.RESULTSFifty ETVs were performed in 40 patients. The average ETVSS was 61 and the success rate at 6 months was 64%. The mean follow-up was 9.9 years (5.2–15.3 years), and the long-term success rate of ETV was 50%. The Kaplan-Meier survival curve continued to show a statistically significant difference among patients with a low, moderate, and high ETVSS, even after 6 months (p = 0.002). After 15 months from the initial ETV, no patients required additional CSF diversion surgery. There was no statistical significance between ETVSS and the long-term full-scale IQ or shunt dependency (p = 0.34 and 0.12, respectively). The radiological improvement in ventricle size was not associated with better future educational outcome.CONCLUSIONSThe ETVSS was correlated with the long-term success rate. After 15 months from the initial ETV, no patients required an additional CSF diversion procedure. The ETVSS was not considered to be correlated with long-term intellectual status.

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“…It has not yet been conclusively proven that shunting gives a better neuropsychological outcome over long term as compared to ETV2). The long term intellectual and psychological outcomes are also currently being evaluated by the International Infant Hydrocephalus Study group31).…”

Section: Long Term Neuropsychological Outcomementioning

confidence: 99%

Endoscopic Third Ventriculostomy : Success and Failure

Deopujari

Karmarkar

Shaikh

2017

J Korean Neurosurg Soc

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Ventricular volume and neurocognitive outcome after endoscopic third ventriculostomy: is shunting a better option? A review

Abstract: The available literature is so far in support of ETV as a valid and effective treatment modality in hydrocephalic patients. No sufficient evidence is available to justify resorting to shunting on the premise that it is associated with a better neurocognitive outcome.

Cited by 17 publications

References 38 publications

Cranial and ventricular size following shunting or endoscopic third ventriculostomy (ETV) in infants with aqueductal stenosis: further insights from the International Infant Hydrocephalus Study (IIHS)

Cranial and ventricular size following shunting or endoscopic third ventriculostomy (ETV) in infants with aqueductal stenosis: further insights from the International Infant Hydrocephalus Study (IIHS)

The long-term outcomes of endoscopic third ventriculostomy in pediatric hydrocephalus, with an emphasis on future intellectual development and shunt dependency

Endoscopic Third Ventriculostomy : Success and Failure

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