Weight Predicts ETV Success in Pediatric Hydrocephalus Patients

Abstract

Objective: The use of endoscopic third ventriculostomy (ETV) for treatment of pediatric hydrocephalus has higher failure rates in younger patients, notably less than 2.5 months of age. Here we investigated the impact of select perioperative variables, specifically gestational age, chronological age, birth weight, and surgical weight, on ETV failure rates. Methods: A retrospective review was performed on patients treated with ETV/CPC from 2010 to 2021 at a large academic center. Analyses included Cox regression for independent predictors and Kaplan-Meier survival curves for time to-event outcomes. Results: 47 patients underwent ETV/CPC at our institution. Overall, 65.6% of the cohort experienced ETV failure with a median failure onset of 36 days postoperatively until failure occurred. Univariate Cox regression analysis showed weight at the time of ETV surgery was significantly inversely associated with ETV failure with a hazard ratio of 0.92 (95% CI 0.82, 0.99). Multivariate analysis redemonstrated the inverse association of weight at time of surgery with ETV failure with hazard ratio of 0.76 (95% CI 0.60, 0.92) The associated ROC had an area under the curve of 0.7490 (95% CI 0.61, 0.89, p=0.02) demonstrating moderate validity in the value of surgery weight as a predictor for ETV failure. The weight cutoff with highest AUC was 4.9 kg (sensitivity: 74% specificity: 69%). Conclusions: Low weight at time of surgery can be an independent predictor of ETV/CPC failure. Previous studies assessing the relationship between ETV/CPC failure and age may have been confounded by not accounting for surgical weight.