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Endoscopic third ventriculostomy versus ventriculoperitoneal shunt in pediatric patients: a decision analysis

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Abstract

Introduction

Uncertainty persists on the best treatment for patients with obstructive hydrocephalus: endoscopic third ventriculostomy (ETV) or shunt, particularly in the younger age groups. We performed decision analysis for quality of life (QOL) outcomes comparing these two procedures.

Materials and methods

Frequency of outcome events for ETV was obtained from the Canadian Pediatric Neurosurgery Study Group (368 patients) and for shunts from two prospective randomized trials, the Shunt Design Trial and the Endoscopic Shunt Insertion Trial (647 patients combined). Quality-adjusted life year (QALY) estimates for various outcomes were obtained from the literature. Decision analysis was performed at 1 year of follow-up for specific age groups, e.g., <1 month, 1–6 months, etc.

Results

Failure from cerebrospinal fluid (CSF) diversion from either procedure was a function of age with higher failures rates in younger patients. Expected QALY at 1 year were marginally higher for ETV for all age groups, but the outcomes were similar enough to be regarded as equivalent. The results, however, were highly sensitive to the assigned health utility value estimates for patients who are well with a functioning ETV or shunt and the severe complication rate from ETV.

Conclusion

Age is a major determinant of outcome from CSF diversion with worse outcomes in young patients. QALY estimates for either ETV or shunt are similar at 1 year.

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References

  1. Vries JK (1978) An endoscopic technique for third ventriculostomy. Surg Neurol 9:165–168

    CAS  PubMed  Google Scholar 

  2. Jones RF, Stening WA, Brydon M (1990) Endoscopic third ventriculostomy. Neurosurgery 26:86–91

    Article  CAS  PubMed  Google Scholar 

  3. Cohen AR (1993) Endoscopic ventricular surgery. Pediatr Neurosurg 19:127–134

    Article  CAS  PubMed  Google Scholar 

  4. Cinalli G, Salazar C, Mallucci C, Yada JZ, Zerah M, Sainte-Rose C (1998) The role of endoscopic third ventriculostomy in the management of shunt malfunction. Neurosurgery 43:1323–1327, (discussion 1327–1329)

    Article  CAS  PubMed  Google Scholar 

  5. Souweidane MM (2005) Endoscopic management of pediatric brain tumors. Neurosurg Focus 18:E1

    Article  PubMed  Google Scholar 

  6. Warf BC (2005) Hydrocephalus in Uganda: the predominance of infectious origin and primary management with endoscopic third ventriculostomy. J Neurosurg 102:1–15

    PubMed  Google Scholar 

  7. Handler MH, Abbott R, Lee M (1994) A near-fatal complication of endoscopic third ventriculostomy: case report. Neurosurgery 35:525–527

    Article  CAS  PubMed  Google Scholar 

  8. McLaughlin MR, Wahlig JB, Kaufmann AM, Albright AL (1997) Traumatic basilar aneurysm after endoscopic third ventriculostomy: case report. Neurosurgery 41:1400–1403

    Article  CAS  PubMed  Google Scholar 

  9. Teo C, Rahman S, Boop FA, Cherny B (1996) Complications of endoscopic neurosurgery. Childs Nerv System 12:248–253

    CAS  Google Scholar 

  10. Koch D, Wagner W (2004) Endoscopic third ventriculostomy in infants of less than 1 year of age: which factors influence the outcome? Childs Nerv Syst 20:405–411

    Article  PubMed  Google Scholar 

  11. Wagner W, Koch D (2005) Mechanisms of failure after endoscopic third ventriculostomy in young infants. J Neurosurg 103:43–49

    PubMed  Google Scholar 

  12. Cinalli G, Sainte-Rose C, Chumas P, Zerah M, Brunelle F, Lot G, Pierre-Kahn A, Renier D (1999) Failure of third ventriculostomy in the treatment of aqueductal stenosis in children. J Neurosurg 90:448–454

    Article  CAS  PubMed  Google Scholar 

  13. Fritsch MJ, Kienke S, Ankermann T, Padoin M, Mehdorn HM (2005) Endoscopic third ventriculostomy in infants. J Neurosurg 103:50–53

    PubMed  Google Scholar 

  14. O’Brien DF, Seghedoni A, Collins DR, Hayhurst C, Mallucci CL (2006) Is there an indication for ETV in young infants in aetiologies other than isolated aqueduct stenosis? Childs Nerv Syst 22(12):1565–1572

    Article  PubMed  Google Scholar 

  15. Beems T, Grotenhuis JA (2002) Is the success rate of endoscopic third ventriculostomy age-dependent? An analysis of the results of endoscopic third ventriculostomy in young children. Childs Nerv Syst 18:605–608

    Article  PubMed  Google Scholar 

  16. Etus V, Ceylan S (2005) Success of endoscopic third ventriculostomy in children less than 2 years of age. Neurosurg Rev 28:284–288

    Article  PubMed  Google Scholar 

  17. Feng H, Huang G, Liao X, Fu K, Tan H, Pu H, Cheng Y, Liu W, Zhao D (2004) Endoscopic third ventriculostomy in the management of obstructive hydrocephalus: an outcome analysis. J Neurosurg 100:626–633

    Article  PubMed  Google Scholar 

  18. Baldauf J, Oertel J, Gaab MR, Schroeder HW (2007) Endoscopic third ventriculostomy in children younger than 2 years of age. Childs Nerv Syst 23:623–626. doi:10.1007/s00381-007-0335-4

    Article  PubMed  Google Scholar 

  19. Drake JM (2007) Endoscopic third ventriculostomy in pediatric patients: the Canadian experience. Neurosurgery 60:881–886 (discussion 881–886). doi:10.1227/01.NEU.0000255420.78431.E7

    Article  PubMed  Google Scholar 

  20. Kadrian D, van Gelder J, Florida D, Jones R, Vonau M, Teo C, Stening W, Kwok B (2005) Long-term reliability of endoscopic third ventriculostomy. Neurosurgery 56:1271–1278, (discussion 1278)

    Article  PubMed  Google Scholar 

  21. Tuli S, Alshail E, Drake J (1999) Third ventriculostomy versus cerebrospinal fluid shunt as a first procedure in pediatric hydrocephalus. Pediatr Neurosurg 30:11–15

    Article  CAS  PubMed  Google Scholar 

  22. Garton HJ, Kestle JR, Cochrane DD, Steinbok P (2002) A cost-effectiveness analysis of endoscopic third ventriculostomy. Neurosurgery 51:69–77, (discussion 77–68)

    Article  PubMed  Google Scholar 

  23. Tuli S, Drake J, Lawless J, Wigg M, Lamberti-Pasculli M (2000) Risk factors for repeated cerebrospinal shunt failures in pediatric patients with hydrocephalus. J Neurosurg 92:31–38

    Article  CAS  PubMed  Google Scholar 

  24. Tuli S, O’Hayon B, Drake J, Clarke M, Kestle J (1999) Change in ventricular size and effect of ventricular catheter placement in pediatric patients with shunted hydrocephalus. Neurosurgery 45:1329–1333, (discussion 1333–1325)

    Article  CAS  PubMed  Google Scholar 

  25. Drake JM, Kestle JR, Milner R, Cinalli G, Boop F, Piatt J Jr., Haines S, Schiff SJ, Cochrane DD, Steinbok P, MacNeil N (1998) Randomized trial of cerebrospinal fluid shunt valve design in pediatric hydrocephalus. Neurosurgery 43:294–303, (discussion 303–295)

    Article  CAS  PubMed  Google Scholar 

  26. Kestle JR, Drake JM, Cochrane DD, Milner R, Walker ML, Abbott R 3rd, Boop FA (2003) Lack of benefit of endoscopic ventriculoperitoneal shunt insertion: a multicenter randomized trial. J Neurosurg 98:284–290

    Article  PubMed  Google Scholar 

  27. Kulkarni AV (2006) Distribution-based and anchor-based approaches provided different interpretability estimates for the Hydrocephalus Outcome Questionnaire. J Clin Epidemiol 59:176–184. doi:10.1016/j.jclinepi.2005.07.011

    Article  PubMed  Google Scholar 

  28. Kulkarni AV, Drake JM, Rabin D, Dirks PB, Humphreys RP, Rutka JT (2004) Measuring the health status of children with hydrocephalus by using a new outcome measure. J Neurosurg 101:141–146

    PubMed  Google Scholar 

  29. Kulkarni AV, Rabin D, Drake JM (2004) An instrument to measure the health status in children with hydrocephalus: the Hydrocephalus Outcome Questionnaire. J Neurosurg 101:134–140

    PubMed  Google Scholar 

  30. Stein SC, Burnett MG, Sonnad SS (2006) Shunts in normal-pressure hydrocephalus: do we place too many or too few? J Neurosurg 105:815–822

    Article  PubMed  Google Scholar 

  31. Tengs TO, Yu M, Luistro E (2001) Health-related quality of life after stroke a comprehensive review. Stroke 32:964–972

    CAS  PubMed  Google Scholar 

  32. Kulkarni AV, Shams I (2007) Quality of life in children with hydrocephalus: results from the Hospital for Sick Children, Toronto. J Neurosurg 107:358–364

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Neurosurgery, University of Toronto, Toronto, Canada

    James M. Drake & Abhaya V. Kulkarni

  2. Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA

    John Kestle

  3. Division of Neurosurgery, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada, M5G 1X8

    James M. Drake

Authors
  1. James M. Drake
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  2. Abhaya V. Kulkarni
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  3. John Kestle
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Correspondence to James M. Drake.

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Drake, J.M., Kulkarni, A.V. & Kestle, J. Endoscopic third ventriculostomy versus ventriculoperitoneal shunt in pediatric patients: a decision analysis. Childs Nerv Syst 25, 467–472 (2009). https://doi.org/10.1007/s00381-008-0761-y

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  • DOI: https://doi.org/10.1007/s00381-008-0761-y

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