scholarly journals Endoscopic Third Ventriculostomy Vs Cerebrospinal Fluid Shunt in the Treatment of Hydrocephalus in Children

Neurosurgery ◽  
2010 ◽  
Vol 67 (3) ◽  
pp. 588-593 ◽  
Author(s):  
◽  
Abhaya V. Kulkarni ◽  
James M. Drake ◽  
John R.W. Kestle ◽  
Conor L. Mallucci ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Relative Risk ◽  
Propensity Score ◽  
Failure Rate ◽  
Endoscopic Third Ventriculostomy ◽  
Third Ventriculostomy ◽  
Postoperative Phase ◽  
Shunt Failure ◽  
Prognostic Features ◽  
Long Term Treatment

Abstract BACKGROUND Endoscopic third ventriculostomy (ETV) has preferentially been offered to patients with more favorable prognostic features compared with shunt. OBJECTIVE To use advanced statistical methods to adjust for treatment selection bias to determine whether ETV survival is superior to shunt survival once the bias of patient-related prognostic factors is removed. METHODS An international cohort of children (≤ 19 years of age) with newly diagnosed hydrocephalus treated with ETV (n = 489) or shunt (n = 720) was analyzed. We used propensity score adjustment techniques to account for 2 important patient prognostic factors: age and cause of hydrocephalus. Cox regression survival analysis was performed to compare time-to-treatment failure in an unadjusted model and 3 propensity score—adjusted models, each of which would adjust for the imbalance in prognostic factors. RESULTS In the unadjusted Cox model, the ETV failure rate was lower than the shunt failure rate from the immediate postoperative phase and became even more favorable with longer duration from surgery. Once patient prognostic factors were corrected for in the 3 adjusted models, however, the early failure rate for ETV was higher than that for shunt. It was only after about 3 months after surgery did the ETV failure rate become lower than the shunt failure rate. CONCLUSIONS The relative risk of ETV failure is initially higher than that for shunt, but after about 3 months, the relative risk becomes progressively lower for ETV. Therefore, after the early high-risk period of ETV failure, a patient could experience a long-term treatment survival advantage compared with shunt. It might take several years, however, to realize this benefit.

Predicting who will benefit from endoscopic third ventriculostomy compared with shunt insertion in childhood hydrocephalus using the ETV Success Score

2010 ◽  
Vol 6 (4) ◽  
pp. 310-315 ◽  
Author(s):  
Abhaya V. Kulkarni ◽  
James M. Drake ◽  
John R. W. Kestle ◽  
Conor L. Mallucci ◽  
Spyros Sgouros ◽  
...  
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Hazard Ratio ◽  
Third Ventriculostomy ◽  
Postoperative Phase ◽  
Shunt Failure ◽  
Shunt Insertion ◽  
Term Survival ◽  
Hazard Ratios ◽  
Childhood Hydrocephalus

Object The authors recently developed and internally validated the ETV Success Score (ETVSS)—a simplified means of predicting the 6-month success rate of endoscopic third ventriculostomy (ETV) for a child with hydrocephalus, based on age, etiology of hydrocephalus, and presence of a previous shunt. A high ETVSS predicts a high chance of early ETV success. In this paper, they assess the clinical utility of the ETVSS by determining whether long-term survival outcomes for ETV versus shunt insertion are different within strata of ETVSS (low, moderate, and high scores). Methods A multicenter, international cohort of children (≤ 19 years old) with newly diagnosed hydrocephalus treated with either ETV (489 patients) or shunt insertion (720 patients) was analyzed. The ETVSS was calculated for all patients. Survival analyses with time-dependent modeling of the hazard ratios were performed. Results For the High-ETVSS Group (255 ETV-treated patients, 117 shunt-treated patients), ETV appeared to have a lower risk of failure right from the early postoperative phase and became more favorable with time. For the Moderate-ETVSS Group (172 ETV-treated patients, 245 shunt-treated patients), ETV appeared to have a higher initial failure rate, but after about 3 months the instantaneous risk of ETV failure became slightly lower than shunt failure (that is, the hazard ratio became < 1). For the Low-ETVSS Group (62 ETV-treated patients, 358 shunt-treated patients), the early risk of ETV failure was much higher than the risk of shunt failure, but the instantaneous risk of ETV failure became lower than the risk of shunt failure at about 6 months following surgery (the hazard ratio became < 1). Conclusions Across all ETVSS strata, the risk of ETV failure becomes progressively lower compared with the risk of shunt failure with increasing time from the surgery. In the best ETV candidates (ETVSS ≥ 80), however, the risk of ETV failure is lower than the risk of shunt failure very soon after surgery, while for less-than-ideal ETV candidates (ETVSS ≤ 70), the risk of ETV failure is initially higher than the risk of shunt failure and only becomes lower after 3–6 months from surgery. These results need to be confirmed by larger, prospective, and preferably randomized studies.

scholarly journals The durability of endoscopic third ventriculostomy and ventriculoperitoneal shunts in children with hydrocephalus following posterior fossa tumor resection: a systematic review and time-to-failure analysis

2017 ◽  
Vol 19 (5) ◽  
pp. 578-584 ◽  
Author(s):  
Michael C. Dewan ◽  
Jaims Lim ◽  
Chevis N. Shannon ◽  
John C. Wellons
Keyword(s):  
Systematic Review ◽  
Failure Analysis ◽  
Posterior Fossa ◽  
Failure Rate ◽  
Endoscopic Third Ventriculostomy ◽  
Tumor Resection ◽  
Third Ventriculostomy ◽  
Time To Failure ◽  
Long Term Treatment ◽  
Csf Diversion

OBJECTIVEUp to one-third of patients with a posterior fossa brain tumor (PFBT) will experience persistent hydrocephalus mandating permanent CSF diversion. The optimal hydrocephalus treatment modality is unknown; the authors sought to compare the durability between endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunt (VPS) therapy in the pediatric population.METHODSThe authors conducted a systematic review of articles indexed in PubMed between 1986 and 2016 describing ETV and/or VPS treatment success/failure and time-to-failure rate in patients < 19 years of age with hydrocephalus related to a PFBT. Additionally, the authors conducted a retrospective review of their institutional series of PFBT patients requiring CSF diversion. Patient data from the systematic review and from the institutional series were aggregated and a time-to-failure analysis was performed comparing ETV and VPS using the Kaplan-Meier method.RESULTSA total of 408 patients were included from 12 studies and the authors' institutional series: 284 who underwent ETV and 124 who underwent VPS placement. The analysis included uncontrolled studies with variable method and timing of CSF diversion and were subject to surgeon bias. No significant differences between cohorts were observed with regard to age, sex, tumor grade or histology, metastatic status, or extent of resection. The cumulative failure rate of ETV was 21%, whereas that of VPS surgery was 29% (p = 0.105). The median time to failure was earlier for ETV than for VPS surgery (0.82 [IQR 0.2–1.8] vs 4.7 months [IQR 0.3–5.7], p = 0.03). Initially the ETV survival curve dropped sharply and then stabilized around 2 months. The VPS curve fell gradually but eventually crossed below the ETV curve at 5.7 months. Overall, a significant survival advantage was not demonstrated for one procedure over the other (p = 0.21, log-rank). However, postoperative complications were higher following VPS (31%) than ETV (17%) (p = 0.012).CONCLUSIONSETV failure occurred sooner than VPS failure, but long-term treatment durability may be higher for ETV. Complications occurred more commonly with VPS than with ETV. Limited clinical conclusions are drawn using this methodology; the optimal treatment for PFBT-related hydrocephalus warrants investigation through prospective studies.

ENDOSCOPIC THIRD VENTRICULOSTOMY (ETV) IS A BETTER ALTERNATIVE FOR VP SHUNT FAILURE IN NON-COMMUNICATING HYDROCEPHALUS

2021 ◽  
pp. 65-67
Author(s):  
Ramesh Tanger ◽  
Dinesh Kumar Barolia ◽  
Arka Chatterjee ◽  
Punit Singh Parihar ◽  
Arun Gupta
Keyword(s):  
Success Rate ◽  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
Shunt Revision ◽  
Third Ventriculostomy ◽  
Communicating Hydrocephalus ◽  
Shunt Failure ◽  
Shunt Insertion ◽  
Vp Shunt

CONTEXT: VP Shunt is most commonly used procedure for hydrocephalus but shunt failure is also the common complication in many patients. Endoscopic third ventriculostomy (ETV) is an accepted procedure for the treatment of obstructive hydrocephalus. The aim of our study is to evaluate the success rate AIM AND OBJECTIVE - of ETV in patients of obstructive hydrocephalus formerly treated by ventriculo-peritoneal (VP shunt) shunt. The failure VP shunt was removed before ETV. MATERIALS AND METHOD: This study was conducted between June 2015 and December 2019 in single unit of our department. Twenty one (n=21) patients were enrolled for this study. All patients were admitted with failure of VP shunt. They were known case of non-communicating hydrocephalus previously operated for VP shunt. Six patients were excluded for ETV because CT/MRI show grossly distorted anatomy of ventricles. Endoscopic third ventriculostomy was attempted in 15 patients, but ventriculostomy was done successfully in 10 patients, rests were treated with revision of VP shunt. All patients in this study were radiologically diagnosed RESULTS: case of hydrocephalus due to aqueduct stenosis. They were experienced VP shunt insertion but there were failure of shunt due to any reason. ETV procedures were done successfully in 10 patients. Out of 10 patients one patient needed shunt insertion due ineffective ETV. Shunt revision was done in 11 patients. There was no serious complication during and after ETV procedures. The follow-up period of patients with successful ETV was 6–60 months. This follow-up was uneventful and peaceful for their parents. ETV can be considered as an alternative treatment for the patients w CONCLUSION: ith VP shunt failure with an acceptable success rate of 80%, although long-term follow-up is needed for these patients.

The Success of Endoscopic Third Ventriculostomy in Children: Analysis of Prognostic Factors

2012 ◽  
Vol 48 (6) ◽  
pp. 352-359 ◽  
Author(s):  
Luciano Lopes Furlanetti ◽  
Marcelo Volpon Santos ◽  
Ricardo Santos de Oliveira
Keyword(s):  
Prognostic Factors ◽  
Endoscopic Third Ventriculostomy ◽  
Third Ventriculostomy

scholarly journals Endoscopic third ventriculostomy and choroid plexus cauterization in infant hydrocephalus: a prospective study by the Hydrocephalus Clinical Research Network

2018 ◽  
Vol 21 (3) ◽  
pp. 214-223 ◽  
Author(s):  
Abhaya V. Kulkarni ◽  
Jay Riva-Cambrin ◽  
Curtis J. Rozzelle ◽  
Robert P. Naftel ◽  
Jessica S. Alvey ◽  
...  
Keyword(s):  
Prospective Study ◽  
Failure Rate ◽  
Intraventricular Hemorrhage ◽  
Endoscopic Third Ventriculostomy ◽  
Treatment Success ◽  
Aqueductal Stenosis ◽  
Research Network ◽  
Third Ventriculostomy ◽  
Matched Pairs ◽  
A Prospective Study

OBJECTIVEHigh-quality data comparing endoscopic third ventriculostomy (ETV) with choroid plexus cauterization (CPC) to shunt and ETV alone in North America are greatly lacking. To address this, the Hydrocephalus Clinical Research Network (HCRN) conducted a prospective study of ETV+CPC in infants. Here, these prospective data are presented and compared to prospectively collected data from a historical cohort of infants treated with shunt or ETV alone.METHODSFrom June 2014 to September 2015, infants (corrected age ≤ 24 months) requiring treatment for hydrocephalus with anatomy suitable for ETV+CPC were entered into a prospective study at 9 HCRN centers. The rate of procedural failure (i.e., the need for repeat hydrocephalus surgery, hydrocephalus-related death, or major postoperative neurological deficit) was determined. These data were compared with a cohort of similar infants who were treated with either a shunt (n = 969) or ETV alone (n = 74) by creating matched pairs on the basis of age and etiology. These data were obtained from the existing prospective HCRN Core Data Project. All patients were observed for at least 6 months.RESULTSA total of 118 infants underwent ETV+CPC (median corrected age 1.3 months; common etiologies including myelomeningocele [30.5%], intraventricular hemorrhage of prematurity [22.9%], and aqueductal stenosis [21.2%]). The 6-month success rate was 36%. The most common complications included seizures (5.1%) and CSF leak (3.4%). Important predictors of treatment success in the survival regression model included older age (p = 0.002), smaller preoperative ventricle size (p = 0.009), and greater degree of CPC (p = 0.02). The matching algorithm resulted in 112 matched pairs for ETV+CPC versus shunt alone and 34 matched pairs for ETV+CPC versus ETV alone. ETV+CPC was found to have significantly higher failure rate than shunt placement (p < 0.001). Although ETV+CPC had a similar failure rate compared with ETV alone (p = 0.73), the matched pairs included mostly infants with aqueductal stenosis and miscellaneous other etiologies but very few patients with intraventricular hemorrhage of prematurity.CONCLUSIONSWithin a large and broad cohort of North American infants, our data show that overall ETV+CPC appears to have a higher failure rate than shunt alone. Although the ETV+CPC results were similar to ETV alone, this comparison was limited by the small sample size and skewed etiological distribution. Within the ETV+CPC group, greater extent of CPC was associated with treatment success, thereby suggesting that there are subgroups who might benefit from the addition of CPC. Further work will focus on identifying these subgroups.

scholarly journals Endoscopic third ventriculostomy for treatment of adult hydrocephalus: long-term follow-up of 163 patients

2016 ◽  
Vol 41 (3) ◽  
pp. E3 ◽  
Author(s):  
Albert M. Isaacs ◽  
Yarema B. Bezchlibnyk ◽  
Heather Yong ◽  
Dilip Koshy ◽  
Geberth Urbaneja ◽  
...  
Keyword(s):  
Clinical Improvement ◽  
Treatment Modality ◽  
Endoscopic Third Ventriculostomy ◽  
Adult Patients ◽  
Third Ventriculostomy ◽  
Long Term Treatment ◽  
Patient Reported ◽  
Csf Diversion

OBJECTIVE The efficacy of endoscopic third ventriculostomy (ETV) for the treatment of pediatric hydrocephalus has been extensively reported in the literature. However, ETV-related long-term outcome data are lacking for the adult hydrocephalus population. The objective of the present study was to assess the role of ETV as a primary or secondary treatment for hydrocephalus in adults. METHODS The authors performed a retrospective chart review of all adult patients (age ≥ 18 years) with symptomatic hydrocephalus treated with ETV in Calgary, Canada, over a span of 20 years (1994–2014). Patients were dichotomized into a primary or secondary ETV cohort based on whether ETV was the initial treatment modality for the hydrocephalus or if other CSF diversion procedures had been previously attempted respectively. Primary outcomes were subjective patient-reported clinical improvement within 12 weeks of surgery and the need for any CSF diversion procedures after the initial ETV during the span of the study. Categorical and actuarial data analysis was done to compare the outcomes of the primary versus secondary ETV cohorts. RESULTS A total of 163 adult patients with symptomatic hydrocephalus treated with ETV were identified and followed over an average of 98.6 months (range 0.1–230.4 months). All patients presented with signs of intracranial hypertension or other neurological symptoms. The primary ETV group consisted of 112 patients, and the secondary ETV consisted of 51 patients who presented with failed ventriculoperitoneal (VP) shunts. After the initial ETV procedure, clinical improvement was reported more frequently by patients in the primary cohort (87%) relative to those in the secondary ETV cohort (65%, p = 0.001). Additionally, patients in the primary ETV group required fewer reoperations (p < 0.001), with cumulative ETV survival time favoring this primary ETV cohort over the course of the follow-up period (p < 0.001). Fifteen patients required repeat ETV, with all but one experiencing successful relief of symptoms. Patients in the secondary ETV cohort also had a higher incidence of complications, with one occurring in 8 patients (16%) compared with 2 in the primary ETV group (2%; p = 0.010), although most complications were minor. CONCLUSIONS ETV is an effective long-term treatment for selected adult patients with hydrocephalus. The overall ETV success rate when it was the primary treatment modality for adult hydrocephalus was approximately 87%, and 99% of patients experience symptomatic improvement after 2 ETVs. Patients in whom VP shunt surgery fails prior to an ETV have a 22% relative risk of ETV failure and an almost eightfold complication rate, although mostly minor, when compared with patients who undergo a primary ETV. Most ETV failures occur within the first 7 months of surgery in patients treated with primary ETV, but the time to failure is more prolonged in patients who present with failed previous shunts.

scholarly journals The importance of extent of choroid plexus cauterization in addition to endoscopic third ventriculostomy for infantile hydrocephalus: a retrospective North American observational study using propensity score–adjusted analysis

2017 ◽  
Vol 20 (6) ◽  
pp. 503-510 ◽  
Author(s):  
Aria Fallah ◽  
Alexander G. Weil ◽  
Kyle Juraschka ◽  
George M. Ibrahim ◽  
Anthony C. Wang ◽  
...  
Keyword(s):  
Propensity Score ◽  
Multivariate Regression ◽  
Propensity Scores ◽  
Endoscopic Third Ventriculostomy ◽  
Third Ventriculostomy ◽  
Infantile Hydrocephalus ◽  
Multivariable Regression ◽  
Csf Diversion ◽  
Shunt Independence ◽  
Choroid Plexus Cauterization

OBJECTIVECombined endoscopic third ventriculostomy (ETC) and choroid plexus cauterization (CPC)—ETV/CPC— is being investigated to increase the rate of shunt independence in infants with hydrocephalus. The degree of CPC necessary to achieve improved rates of shunt independence is currently unknown.METHODSUsing data from a single-center, retrospective, observational cohort study involving patients who underwent ETV/CPC for treatment of infantile hydrocephalus, comparative statistical analyses were performed to detect a difference in need for subsequent CSF diversion procedure in patients undergoing partial CPC (describes unilateral CPC or bilateral CPC that only extended from the foramen of Monro [FM] to the atrium on one side) or subtotal CPC (describes CPC extending from the FM to the posterior temporal horn bilaterally) using a rigid neuroendoscope. Propensity scores for extent of CPC were calculated using age and etiology. Propensity scores were used to perform 1) case-matching comparisons and 2) Cox multivariable regression, adjusting for propensity score in the unmatched cohort. Cox multivariable regression adjusting for age and etiology, but not propensity score was also performed as a third statistical technique.RESULTSEighty-four patients who underwent ETV/CPC had sufficient data to be included in the analysis. Subtotal CPC was performed in 58 patients (69%) and partial CPC in 26 (31%). The ETV/CPC success rates at 6 and 12 months, respectively, were 49% and 41% for patients undergoing subtotal CPC and 35% and 31% for those undergoing partial CPC. Cox multivariate regression in a 48-patient cohort case-matched by propensity score demonstrated no added effect of increased extent of CPC on ETV/CPC survival (HR 0.868, 95% CI 0.422–1.789, p = 0.702). Cox multivariate regression including all patients, with adjustment for propensity score, demonstrated no effect of extent of CPC on ETV/CPC survival (HR 0.845, 95% CI 0.462–1.548, p = 0.586). Cox multivariate regression including all patients, with adjustment for age and etiology, but not propensity score, demonstrated no effect of extent of CPC on ETV/CPC survival (HR 0.908, 95% CI 0.495–1.664, p = 0.755).CONCLUSIONSUsing multiple comparative statistical analyses, no difference in need for subsequent CSF diversion procedure was detected between patients in this cohort who underwent partial versus subtotal CPC. Further investigation regarding whether there is truly no difference between partial versus subtotal extent of CPC in larger patient populations and whether further gain in CPC success can be achieved with complete CPC is warranted.

scholarly journals Functional and radiological parameters to assess outcome of endoscopic third ventriculostomy in shunt failure patients

2019 ◽  
Vol 14 (2) ◽  
pp. 65
Author(s):  
Monika Bawa ◽  
RN. Naga Santhosh Irrinki ◽  
Shalini Hegde ◽  
Rajesh Chhabra ◽  
Vivek Gupta ◽  
...  
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Third Ventriculostomy ◽  
Shunt Failure ◽  
Radiological Parameters
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