Endoscopic management of intraventricular shunt-related cystic compartment in paediatric patients

Background. Intraventricular uniloculated compartments are relatively seen frequently in children previously treated with ventriculoperitoneal shunts for hydrocephalus. These compartments may present before shunt insertion and even as an end result to the shunt gliosis. Although the availability of different surgical modalities for the management of such loculations but till now there is no consensus about a single therapeutic approach for its management. Objective. The aim of this study is to assess the role of neuroendoscopy in management of uniloculated compartments, in pediatric cases who underwent shunting for hydrocephalus, to avoid multiple shunt insertion and even to eliminate the need for the preexisting shunt system.Patients and Methods. We retrospectively studied 44 consecutive previously shunted patients with isolated intraventricular compartment who underwent 58 endoscopic procedures by a single surgeon during the period between February 2015 and February 2018. These procedures included endoscopic cyst fenestration, intraventricular septum pellucidotomy, foraminoplasty and additionally third ventriculostomy in some cases was added to the previous procedures. Multiloculated hydrocephalus and cysts related to the tumours were excluded. Clinical, radiological and surgical data were assessed.Results. The most common cause of a single loculation in those patients was neuroepithelial cyst (20 cases) followed by post shunt isolated compartment (12 cases), meningitis (8 cases) and four cases of intraventricular haemorrhage. The patient's age varied from two months up to seven years (mean = 3.2 years). The follow-up period was ranged from (2-49 months) with the mean of 12.3 months. The overall success of restoration of communication between the uniloculated compartment and the ventricular system was achieved in 36 patients (81.8%), with 28 (63.6%) patient needed only one shunt and eight (18.2%) patients became independent of their previous shunts. Fourteen repeated endoscopic procedures were considered necessary in ten patients for either reopening of a closed stoma and/or shunt revision and finally, eight patient (18%) required additional shunt insertion during follow up period. The complications encountered were minor and reversible (CSF leak in two cases, infection in two cases, subdural fluid collection in four cases) with no mortality.Conclusion. Minimal invasive endoscopic technique is a useful operative alternative to control uniloculated compartments in patients with previous ventriculoperitoneal shunts. It does not only simplify the existing shunt system by restoration of the communication between the loculated compartment and the draining shunt but it may eliminate the need for external shunt in some cases as well.

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

10.36106/ijar/9302582 ◽

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.

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Late pediatric ventriculoperitoneal shunt failures: a Singapore tertiary institution's experience

Neurosurgical FOCUS ◽

10.3171/2016.8.focus16277 ◽

2016 ◽

Vol 41 (5) ◽

pp. E7 ◽

Cited By ~ 4

Author(s):

Lester Lee ◽

Sharon Low ◽

David Low ◽

Lee Ping Ng ◽

Colum Nolan ◽

...

Keyword(s):

Retrospective Study ◽

Pediatric Patients ◽

Shunt Revision ◽

Shunt Failure ◽

Shunt Insertion ◽

Ventriculoperitoneal Shunts ◽

Effects Of Aging ◽

Age And Sex

OBJECTIVE The introduction of ventriculoperitoneal shunts changed the way hydrocephalus was treated. Whereas much is known about the causes of shunt failure in the first few years, there is a paucity of data in the literature regarding the cause of late shunt failures. The authors conducted a study to find out the different causes of late shunt failures in their institution. METHODS A 10-year retrospective study of all the patients who were treated in the authors' hospital between 2006 and 2015 was conducted. Late shunt failures included those in patients who had to undergo shunt revision more than 5 years after their initial shunt insertion. The patient's notes and scans were reviewed to obtain the age and sex of the patient, the time it took for the shunt to fail, the reason for failure, and the patient's follow-up. RESULTS Forty-six patients in the authors' institution experienced 48 late shunt failures in the last 10 years. Their ages ranged from 7 to 26 years (12.23 ± 4.459 years [mean ± SD]). The time it took for the shunts to fail was between 6 and 24 years (mean 10.25 ± 3.77 years). Reasons for failure resulting in shunt revision include shunt fracture in 24 patients (50%), shunt blockage in 14 patients (29.2%), tract fibrosis in 6 patients (12.5%), shunt dislodgement in 2 patients (4.2%), and shunt erosion in 2 patients (4.2%). Postoperative follow-up for the patients ranged from 6 to 138 months (mean 45.15 ± 33.26 months). CONCLUSIONS Late shunt failure is caused by the effects of aging on the shunt, and the complications are different from early shunt failure. A large proportion are complications associated with shunt calcification. The authors advocate a long follow-up for pediatric patients with shunts in situ to monitor them for various causes of late shunt failure.

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Early Outcome of Endoscopic Third Ventriculostomy With or Without Choroid Plexus Cauterization and Ventriculoperitoneal Shunt as Primary Treatment of Hydrocephalus in Infants With Myelomeningocele

Neurosurgery ◽

10.1093/neuros/nyz310_347 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Bamidele O Adebayo ◽

Okezie Kanu ◽

Olufemi B Bankole ◽

Omotayo Ojo

Keyword(s):

Success Rate ◽

Choroid Plexus ◽

Ventriculoperitoneal Shunt ◽

Endoscopic Third Ventriculostomy ◽

Successful Outcome ◽

Csf Leak ◽

Third Ventriculostomy ◽

Prospective Longitudinal ◽

Choroid Plexus Cauterization

Abstract INTRODUCTION Myelomeningocele is associated with hydrocephalus in 35% to 90% of cases. Hydrocephalus is usually treated with insertion of ventriculoperitoneal shunt. However, endoscopic third ventriculostomy with or without choroid plexus cauterization is a viable alternative. METHODS A prospective longitudinal study from January 2016 to December 2018 on patients with myelomeningocele who presented to Lagos University Teaching Hospital, Nigeria and who had hydrocephalus.Informed consent for research and surgery were obtained. ETV with or without CPC or VPS was done with general anesthesia using standard operative techniques. Patients were followed up monthly for at least 6 mo. The surgery was adjudged failed if there was progressive head enlargement as well as other signs of hydrocephalus necessitating another surgery for hydrocephalus. RESULTS A total of 48 patients completed the study. A total of Six patients were lost to follow-up. Age range of the patients was 1 to 44 wk. A total of Five patients had ETV, 21 had ETV/CPC, and 22 patients had VPS. The mean OFC at the time of surgery were 45.3 cm and 44.9 cm for the endoscopic and VPS arms respectively. There were 2 (7.6%) cases of CSF leak in the endoscopic arm and 3 (13.6%) cases of wound dehiscence, with 1 (4.5%) case of CSF leak in the VPS arm. Mean age at surgery for ETV/CPC arm was 12.3 wand 11.5 wk for the VPS arm. Mean time to failure was 9.9 and 6.3 wk for endoscopic and VPS arms respectively. Four (80%) of the patients who had ETV had a successful outcome, 11 (52.3%) of those who had ETV/CPC had a successful outcome and 13 (59%) of those who had VPS had a successful outcome. At 6 mo follow up, overall success rate for the endoscopic arm was 57.6% and 59% for the VPS. CONCLUSION Endoscopic third ventriculostomy with or without choroid plexus cauterization had similar success rate with VPS at 6 mos.

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Management of Adult Hydrocephalus With Ventriculoperitoneal Shunts: Long-term Single-Institution Experience

Neurosurgery ◽

10.1227/neu.0b013e31821ffa9e ◽

2011 ◽

Vol 69 (4) ◽

pp. 774-781 ◽

Cited By ~ 54

Author(s):

G Kesava Reddy ◽

Papireddy Bollam ◽

Runhua Shi ◽

Bharat Guthikonda ◽

Anil Nanda

Keyword(s):

Median Time ◽

Adult Patients ◽

Shunt Revision ◽

Shunt Failure ◽

Single Institution ◽

Ventriculoperitoneal Shunts ◽

Shunt Placement ◽

Ventriculoperitoneal Shunting

Abstract BACKGROUND: Ventriculoperitoneal shunting is the most widely used neurosurgical procedure for the management of hydrocephalus. OBJECTIVE: To evaluate our long-term single-institution experience in the management of adult hydrocephalus patients with ventriculoperitoneal shunts. METHODS: Adult patients who underwent ventriculoperitoneal shunt placement for hydrocephalus from October 1990 to October 2009 were included. Medical charts, operative reports, imaging studies, and clinical follow-up evaluations were reviewed and analyzed retrospectively for clinical outcome in adult hydrocephalus patients. RESULTS: A total of 683 adult patients were included in the study. The most common etiologies of hydrocephalus include idiopathic (29%), tumors and cysts (20%), postcraniotomy (13%), and subarachnoid hemorrhage (13%). The overall shunt failure rate was 32%, and the majority (74%) of shunt revisions occurred within the first 6 months. The median time to first shunt revision was 9.31 months. Etiology of hydrocephalus showed a significant impact on the incidence of shunt revision/failure and on the median time to shunt revision. Similarly, the type of hydrocephalus had a significant effect on the incidence of shunt failure and the median time to shunt revision. CONCLUSION: A large proportion of patients (32%) experience shunt failure after shunt placement for hydrocephalus. Although the overall incidence of shunt revision was comparable to previously reported studies, the fact that a large proportion of adult populations with shunt placement experience shunt failure is a concern.

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The necessity of shunt series

Journal of Neurosurgery Pediatrics ◽

10.3171/2010.8.peds09557 ◽

2010 ◽

Vol 6 (5) ◽

pp. 468-473 ◽

Cited By ~ 13

Author(s):

Michael Vassilyadi ◽

Zac L. Tataryn ◽

Fahad Alkherayf ◽

Kristin Udjus ◽

Enrique C. G. Ventureyra

Keyword(s):

Opening and closure of intraventricular neuroendoscopic procedures in infants under 1 year of age: institutional technique, case series and review of the literature

Child s Nervous System ◽

10.1007/s00381-020-04895-x ◽

2020 ◽

Vol 37 (1) ◽

pp. 101-105 ◽

Cited By ~ 1

Author(s):

M. D. Cearns ◽

M. Kommer ◽

A. Amato-Watkins ◽

E. Campbell ◽

T. Beez ◽

...

Keyword(s):

Endoscopic Third Ventriculostomy ◽

Case Series ◽

Csf Leak ◽

Third Ventriculostomy ◽

Retrospective Case ◽

Infantile Hydrocephalus ◽

Wound Breakdown ◽

Csf Leakage ◽

Clinical Records

Abstract Purpose Intraventricular neuroendoscopic techniques, particularly third ventriculostomy, are employed increasingly in the management of infantile hydrocephalus. However, surgical access to the ventricular cavities is associated with a risk of post-operative cerebrospinal fluid (CSF) leak. Here, we describe a structured, multi-layered approach to wound opening and closure which aims to maximise the natural tissue barriers against CSF leakage. We present a series of patients undergoing this technique and subsequently review the literature regarding opening and closure techniques in paediatric intraventricular neuroendoscopic procedures. Methods We performed a retrospective case series analysis of patients under 1 year of age who underwent intraventricular neuroendoscopic procedures in a single institution over a 5-year period. Patients were identified from an institutional operative database, and operation notes and clinical records were subsequently reviewed. Results 28 patients fulfilled the inclusion criteria for this study. The mean age at operation was 9 weeks. 27 patients underwent endoscopic third ventriculostomy whilst 1 underwent endoscopic septostomy, and all patients underwent our structured, multi-layered opening and closure technique. Follow-up ranged from 4 months to 5 years. There were no cases of post-operative CSF leak, infection or wound breakdown. 12 patients remained shunt-free at the last follow-up, with the remaining 16 requiring shunt insertion for progressive hydrocephalus at a mean of 24 days post-operatively. Conclusion Various methods aiming to prevent post-operative CSF leak have been reported in the literature. We propose that our institutional technique may be of benefit in minimising this risk in infants undergoing endoscopic third ventriculostomy and similar intraventricular neuroendoscopic procedures.

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Endoscopic third ventriculostomy for obstructive hydrocephalus

Romanian Neurosurgery ◽

10.33962/roneuro-2020-039 ◽

2020 ◽

pp. 269-274

Author(s):

Hassan Z.A. Dixon ◽

Yasir M. Hamandi ◽

Ammar M.A. Mahmmoud ◽

Samer S. Hoz ◽

Zahraa F. Al-Sharshahi

Keyword(s):

Success Rate ◽

Endoscopic Third Ventriculostomy ◽

Obstructive Hydrocephalus ◽

Csf Leak ◽

Third Ventriculostomy ◽

Success Rates ◽

Shunt Insertion ◽

Female Ratio ◽

Common Cause ◽

Select Group

Introduction: Obstructive hydrocephalus has long been managed by valve-regulated shunts. These shunts are associated with a myriad of short and long-term complications. This has fueled interest in Endoscopic Third Ventriculostomy (ETV) which provides a more physiological pathway for cerebrospinal fluid (CSF) diversion while avoiding many shunt-related complications. Aim: The objective of this study is to analyze the outcomes of ETV at our institution, focusing on the indications, success rates, and short-term complications. Methods: Between July 2010 and September 2015, 47 patients with obstructive hydrocephalus underwent ETV at the Neurosurgery Teaching Hospital in Baghdad/ Iraq. We retrospectively analyzed the data of these patients using hospital health records. Simple statistics were performed using SPSS Version 20. A standardized surgical technique was employed in all cases. Results: The mean age was 4.4 years (range 40 days - 38 years). The male: female ratio was 1.23:1 (55% males and 45% females). The most common cause of obstructive hydrocephalus in patients undergoing ETV was aqueductal stenosis (62%; N=29). The second most common cause was posterior fossa tumours (23%; N=11). The overall success rate for ETV was 68%. The net post-operative complication rate was 13% (N=6). CSF leak and seizures were the only two charted post-operative complications at the rates of 9%(N=4) and 4% (N=2), accordingly. No deaths were recorded. Conclusion: ETV is a viable alternative to shunt insertion in a select group of patients with obstructive hydrocephalus, with acceptable success rate and safety profile.

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Reduced ventricular shunt rate in very preterm infants with severe intraventricular hemorrhage: an institutional experience

Journal of Neurosurgery Pediatrics ◽

10.3171/2012.7.peds11504 ◽

2012 ◽

Vol 10 (5) ◽

pp. 357-364 ◽

Cited By ~ 21

Author(s):

Nima Alan ◽

Sunil Manjila ◽

Nori Minich ◽

Nancy Bass ◽

Alan R. Cohen ◽

...

Keyword(s):

Bronchopulmonary Dysplasia ◽

Gestational Age ◽

Intraventricular Hemorrhage ◽

Well Being ◽

Shunt Revision ◽

Shunt Insertion ◽

Vp Shunt ◽

The Past ◽

Period 2

Object Although survival for extremely low gestational age newborns (ELGANs) has improved in the past 3 decades, these infants remain prone to complications of prematurity, including intraventricular hemorrhage (IVH). The authors reviewed the outcomes for an entire cohort of ELGANs who suffered severe IVH at their institution during the past 12 years to gain a better understanding of the natural history of IVH and frequency of ventriculoperitoneal (VP) shunt placement in this population. Methods Data from the neonatal ICU (NICU) database, neurosurgery operative log, and medical records were used to identify and follow up all ELGANs who suffered a severe IVH between 1997 and 2008. Trends between Period 1 (1997–2001) and Period 2 (2004–2008) were analyzed using the Pearson chi-square test. Results Between 1997 and 2008, 1335 ELGANs were admitted to the NICU at the authors' institution within 3 days of birth, and 111 (8.3%) of these infants suffered a severe IVH. Survival to 2 years, incidence of severe IVH, neonatal risk factors (gestational age, birth weight, and incidence of necrotizing enterocolitis), ventriculomegaly on cranial ultrasonography, and use of serial lumbar punctures for symptomatic hydrocephalus were all stable. Infants from Period 2 had a significantly lower incidence of bronchopulmonary dysplasia and sepsis than infants from Period 1 (both p < 0.001). All ELGANs with severe IVH and ventriculomegaly underwent long-term follow-up to identify shunt status at late follow-up. Twenty-two ELGANs (20%) with severe IVH required a temporary ventriculosubgaleal (VSG) shunt. Three infants with VSG shunts showed spontaneous hydrocephalus resolution, and 2 infants died of unrelated causes during the neonatal admission. The temporary VSG shunt complication rate was 20% (12% infection and 8% malfunction). Sixteen percent of all ELGANs (18 of 111) with severe IVH eventually required permanent ventricular shunt insertion. Six (35%) of 17 infants with a permanent VP shunt required at least 1 permanent shunt revision during the 1st year. The proportion of ELGANs with severe IVH who required a temporary VSG (35%) or permanent VP shunt (30%) during Period 1 decreased by more than 60% in Period 2 (10% [p = 0.005] and 8.3% [p = 0.009], respectively). Conclusions The authors report for the first time a marked reduction over the past 12 years in the proportion of ELGANs with severe IVH who required surgical intervention for hydrocephalus. Using the NICU database, the authors were able to identify and follow all ELGANs with severe IVH and ventriculomegaly. They speculate that the reduction in ventricular shunt rate results from improved neonatal medical care, including reduced infection, improved bronchopulmonary dysplasia, and postnatal steroid avoidance, which may aid innate repair mechanisms. Multicenter prospective trials and detailed analyses of NICU parameters of neonatal well-being are needed to understand how perinatal factors influence the propensity to require ventricular shunting.

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Long-term follow-up of endoscopic third ventriculostomy performed in the pediatric population

Journal of Neurosurgery Pediatrics ◽

10.3171/2015.11.peds15212 ◽

2016 ◽

Vol 17 (6) ◽

pp. 734-738 ◽

Cited By ~ 16

Author(s):

Matthew G. Stovell ◽

Rasheed Zakaria ◽

Jonathan R. Ellenbogen ◽

Mathew J. Gallagher ◽

Michael D. Jenkinson ◽

...

Keyword(s):

Failure Rate ◽

Endoscopic Third Ventriculostomy ◽

Obstructive Hydrocephalus ◽

Third Ventriculostomy ◽

Shunt Insertion ◽

Vp Shunt ◽

Additional Surgery ◽

Long Term Follow Up

OBJECTIVE Endoscopic third ventriculostomy (ETV) is an effective treatment for obstructive hydrocephalus and avoids the risk for foreign-body infection associated with ventriculoperitoneal (VP) shunts. The short-term failure rate of ETV strongly depends on the indications for its use but is generally thought to be lower in the long term than that of VP shunts. However, few studies are available with long-term follow-up data of ETV for hydrocephalus in children. The authors reviewed the long-term success of ETV at their institution to investigate the rate of any late failures of this procedure. METHODS Between April 1998 and June 2006, 113 children (including neonates and children up to 16 years old) had primary or secondary ETV for different causes of hydrocephalus. The patients' medical records and the authors' electronic operation database were reviewed for evidence of additional surgery (i.e., repeat ETV or VP shunt insertion). These records were checked at both the pediatric and adult neurosurgical hospitals for those patients who had their care transferred to adult services. RESULTS The median length of follow-up was 8.25 years (range 1 month to 16 years). Long-term follow-up data for 96 patients were available, 47 (49%) of whom had additional ETV or VP shunt insertion for ETV failure. Twenty patients (21%) had a second procedure within 1 month, 17 patients (18%) between 1 and 12 months, 7 patients (7%) between 1 and 5 years, and 3 patients (3%) between 5 and 8 years. CONCLUSIONS In the authors' series, ETV had an initial early failure rate for the treatment of pediatric hydrocephalus as reported previously, and this rate significantly depended on patient age and hydrocephalus etiology. Once stabilized and effective, ETV appeared to be durable but not guaranteed, and some late decline in effectiveness was observed, with some ETV failures occurring many years later. Thus, successful ETV in children cannot be guaranteed for life, and some form of follow-up is recommended long term into adulthood.

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Endoscopic third ventriculostomy and choroid plexus cauterization with a rigid neuroendoscope in infants with hydrocephalus

Journal of Neurosurgery Pediatrics ◽

10.3171/2015.5.peds14692 ◽

2016 ◽

Vol 17 (2) ◽

pp. 163-173 ◽

Cited By ~ 14

Author(s):

Alexander G. Weil ◽

Aria Fallah ◽

Parthasarathi Chamiraju ◽

John Ragheb ◽

Sanjiv Bhatia

Keyword(s):

Choroid Plexus ◽

North American ◽

Endoscopic Third Ventriculostomy ◽

Aqueductal Stenosis ◽

Csf Leak ◽

Third Ventriculostomy ◽

Children's Hospital ◽

Children’S Hospital ◽

Choroid Plexus Cauterization

OBJECT Combining endoscopic third ventriculostomy (ETV) with choroid plexus cauterization (CPC) has been shown to improve the success rate compared with ETV alone in infants (less than 24 months) with hydrocephalus who were treated in developing countries. The authors sought to evaluate the safety and efficacy of this procedure, using a rigid neuroendoscope, in a single North American center, and to assess whether the ETV success score (ETVSS), the CURE Children’s Hospital of Uganda ETVSS (CCHU ETVSS), and other pre- and intraoperative variables could predict success. METHODS The authors performed a retrospective review of consecutive ETV/CPC procedures performed using a rigid neuroendoscope to treat infantile hydrocephalus. The infants underwent the procedure at Miami Children’s Hospital between January 2007 and 2014, with at least one postoperative follow-up. Duration of follow-up or time to failure of ETV/CPC, the primary outcome measure, was documented. A repeat CSF diversion procedure or death was considered as a failure of ETV/CPC. The time to event was measured using a Kaplan-Meier analysis. The authors analyzed ETVSS, CCHU ETVSS, and pre- and intraoperative variables to determine their suitability to predict success. RESULTS Eighty-five patients (45 boys) with a mean age of 4.3 months (range 1 day to 20 months) underwent ETV/CPC. Etiology included intraventricular hemorrhage of prematurity in 44 patients (51.7%), myelomeningocele (MMC) in 7 (8.2%), congenital aqueductal stenosis in 12 (14.1%), congenital communicating hydrocephalus in 6 (7.1%), Dandy-Walker complex in 6 (7.1%), postinfectious hydrocephalus in 5 (5.8%), and other cause in 5 (5.8%). Six procedure-related complications occurred in 5 (5.8%) patients, including 2 hygromas, 1 CSF leak, and 3 infections. There were 3 mortalities in this cohort. ETV/CPC was successful in 42.1%, 37.7%, and 36.8% of patients at 6, 12, and 24 months follow-up, respectively. The median (95% CI) time to ETV/CPC failure was 4.0 months (0.9–7.1 months). In univariate analyses, both the ETVSS (hazard ratio [HR] 1.03; 95% CI 1.01–1.05; p = 0.004) and CCHU ETVSS (HR 1.48; 95% CI 1.04–2.09; p = .028) were predictive of outcome following ETV/CPC. In multivariate analysis, the presence of prepontine scarring was associated with ETV/CPC failure (HR 0.34; 95% CI 0.19–0.63; p < 0.001). Other variables, such as radiological criteria (prepontine interval, prepontine space, aqueductal stenosis, Third Ventricular Morphology Index) and intraoperative findings (ventriculostomy pulsations, extent of CPC), did not predict outcome. CONCLUSIONS ETV/CPC is a feasible alternative to ETV and ventriculoperitoneal shunt in infants with hydrocephalus. Both the ETVSS and CCHU ETVSS predicted success following ETV/CPC in this single-center North American cohort of patients.

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