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Endoscopic third ventriculostomy inpatient failure rates compared with shunting in post-hemorrhagic hydrocephalus of prematurity

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Abstract

Purpose

Endoscopic third ventriculostomy (ETV) has gained traction as a method for treating post-hemorrhagic hydrocephalus of prematurity (PHHP) in an effort to obviate lifelong shunt dependence in neonates. However, data remains limited regarding inpatient failures.

Methods

A retrospective analysis of the NIS between 1998 and 2014 was performed. Discharges with age < 1 year and ICD-9-CM codes indicating intraventricular hemorrhage of prematurity (772.1x) and ETV/shunt (02.22 and 02.3x) were included. Patients with ICD-9-CM codes for ventricular drain/reservoir (02.21) were excluded to prevent confounding. Time trend series plots were created. Yearly trends were quantified using logarithmic regression analysis. Kaplan-Meier curves were utilized to analyze time to treatment failure. Time to failure for each treatment was compared using log-rank.

Results

A total of 11,017 discharges were identified. ETV was more likely to be utilized at < 29 weeks gestational age (p = 0.0039) and birth weight < 1000 g (p = 0.0039). Shunts were less likely to fail in older and heavier newborns (OR 0.836 p = 0.00456, OR 0.828 p = 0.0001, respectively). Those initially shunted had lower failure rates compared with ETV (OR 0.44, p < 0.0001) but time to failure was longer with ETV (p = 0.04562). 79.5% of ETVs that failed were shunted after the first failure. Shunts were much less likely to undergo ETV if they failed (OR 0.21, p < 0.0001). Higher grade IVH was predictive of shunt failure but not ETV (OR 2.36, p = 0.0129).

Conclusions

Although ETV can be effective in PHHP, it has a much higher initial failure rate than shunting and should thus be chosen based on a multifactorial approach.

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Authors and Affiliations

  1. Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope Life Center, 2nd floor, 1095 NW 14th Terrace, Miami, FL, 33136, USA

    Evan Luther, David McCarthy, Shaina Sedighim & Toba Niazi

  2. Department of Neurological Surgery, Nicklaus Children’s Hospital, Miami, FL, USA

    Toba Niazi

Authors
  1. Evan Luther
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  2. David McCarthy
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  4. Toba Niazi
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Correspondence to Evan Luther.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The consent process was waived since it was a retrospective study of patient data stripped of all identifying information.

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Luther, E., McCarthy, D., Sedighim, S. et al. Endoscopic third ventriculostomy inpatient failure rates compared with shunting in post-hemorrhagic hydrocephalus of prematurity. Childs Nerv Syst 36, 559–568 (2020). https://doi.org/10.1007/s00381-019-04465-w

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