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Endoscopic third ventriculocisternostomy in hydrocephalic children under 2 years of age: appropriate or not? A single-center retrospective cohort study

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Abstract

Purpose

Treating hydrocephalus can be difficult in children under the age of 2 years because a high amount of uncertainty exists as to which treatment to perform. In this retrospective cohort study, we analyzed children under the age of 2 years with hydrocephalus undergoing an endoscopic third ventriculocisternostomy (ETV) with respect to ETV outcome.

Methods

In 59 consecutive patients under the age of 2 years, an ETV was performed between 1999 and 2010 at the Erasmus MC, Sophia Children’s Hospital. Demographics, etiology of hydrocephalus, and radiological data were extracted retrospectively from the patients’ medical records and operative reports and related to outcome. ETV Success Score (ETVSS) was used to retrospectively calculate the probability of success related to the actual outcome.

Results

In this series, 42.4 % of patients had a successful ETV. The only statistically significant finding concerned age. The failed ETV patients appeared to be younger (0.52 ± 0.60 vs. 0.86 ± 0.56 year, p = 0.005), and when using a cutoff age of 6 months only, five out of 32 infants had a successful ETV (p = 0.002). Of the children with an arachnoid cyst, 57.1 % were treated successfully with an ETV. Of the five patients with a high probability of ETV success, four (80 %) were indeed successfully treated with ETV (p = 0.049).

Conclusions

Our data confirm the overall ineffectiveness of an ETV in children under the age of 6 months. Nevertheless, using the ETVSS is recommended to aid in the decision-making process even in patients under the age of 6 months.

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References

  1. Platenkamp M, Hanlo PW, Fischer K, Gooskens RH (2007) Outcome in pediatric hydrocephalus: a comparison between previously used outcome measures and the hydrocephalus outcome questionnaire. J Neurosurg 107:26–31

    PubMed  Google Scholar 

  2. Burtscher J, Bartha L, Twerdy K, Eisner W, Benke T (2003) Effect of endoscopic third ventriculostomy on neuropsychological outcome in late onset idiopathic aqueduct stenosis: a prospective study. J Neurol Neurosurg Psychiatry 74:222–225

    Article  PubMed  CAS  Google Scholar 

  3. Elgamal EA, El-Dawlatly AA, Murshid WR, El-Watidy SM, Jamjoom ZA (2011) Endoscopic third ventriculostomy for hydrocephalus in children younger than 1 year of age. Childs Nerv Syst 27:111–116

    Article  PubMed  Google Scholar 

  4. 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 

  5. Kulkarni AV, Drake JM, Armstrong DC, Dirks PB (2000) Imaging correlates of successful endoscopic third ventriculostomy. J Neurosurg 92:915–919

    Article  PubMed  CAS  Google Scholar 

  6. Kulkarni AV, Drake JM, Kestle JR, Mallucci CL, Sgouros S, Constantini S (2010) Endoscopic third ventriculostomy vs cerebrospinal fluid shunt in the treatment of hydrocephalus in children: a propensity score-adjusted analysis. Neurosurgery 67:588–593

    Article  PubMed  Google Scholar 

  7. Melikian A, Korshunov A (2010) Endoscopic third ventriculostomy in patients with malfunctioning CSF-shunt. World Neurosurg 74:532–537

    Article  PubMed  Google Scholar 

  8. O'Brien DF, Javadpour M, Collins DR, Spennato P, Mallucci CL (2005) Endoscopic third ventriculostomy: an outcome analysis of primary cases and procedures performed after ventriculoperitoneal shunt malfunction. J Neurosurg 103:393–400

    PubMed  Google Scholar 

  9. Sufianov AA, Sufianova GZ, Iakimov IA (2010) Endoscopic third ventriculostomy in patients younger than 2 years: outcome analysis of 41 hydrocephalus cases. J Neurosurg Pediatr 5:392–401

    Article  PubMed  Google Scholar 

  10. Surash S, Chumas P, Bhargava D, Crimmins D, Straiton J, Tyagi A (2010) A retrospective analysis of revision endoscopic third ventriculostomy. Childs Nerv Syst 26:1693–1698

    Article  PubMed  Google Scholar 

  11. Drake JM, Kulkarni AV, Kestle J (2009) Endoscopic third ventriculostomy versus ventriculoperitoneal shunt in pediatric patients: a decision analysis. Childs Nerv Syst 25:467–472

    Article  PubMed  Google Scholar 

  12. Gallo P, Szathmari A, De Biasi S, Mottolese C (2010) Endoscopic third ventriculostomy in obstructive infantile hydrocephalus: remarks about the so-called ‘unsuccessful cases’. Pediatr Neurosurg 46:435–441

    Article  PubMed  Google Scholar 

  13. Kulkarni AV, Drake JM, Kestle JR, Mallucci CL, Sgouros S, Constantini S (2010) Predicting who will benefit from endoscopic third ventriculostomy compared with shunt insertion in childhood hydrocephalus using the ETV Success Score. J Neurosurg Pediatr 6:310–315

    Article  PubMed  Google Scholar 

  14. Lacy M, Oliveira M, Austria E, Frim MD (2009) Neurocognitive outcome after endoscopic third ventriculocisterostomy in patients with obstructive hydrocephalus. J Int Neuropsychol Soc 15:394–398

    Article  PubMed  Google Scholar 

  15. Benedict RH, Weinstock-Guttman B, Fishman I, Sharma J, Tjoa CW, Bakshi R (2004) Prediction of neuropsychological impairment in multiple sclerosis: comparison of conventional magnetic resonance imaging measures of atrophy and lesion burden. Arch Neurol 61:226–230

    Article  PubMed  Google Scholar 

  16. Di Rocco C, Cinalli G, Massimi L, Spennato P, Cianciulli E, Tamburrini G (2006) Endoscopic third ventriculostomy in the treatment of hydrocephalus in pediatric patients. Adv Tech Stand Neurosurg 31:119–219

    Article  PubMed  Google Scholar 

  17. Kulkarni AV, Shams I, Cochrane DD, McNeely PD (2010) Quality of life after endoscopic third ventriculostomy and cerebrospinal fluid shunting: an adjusted multivariable analysis in a large cohort. J Neurosurg Pediatr 6:11–16

    Article  PubMed  Google Scholar 

  18. Faggin R, Bernardo A, Stieg P, Perilongo G, d'Avella D (2009) Hydrocephalus in infants less than six months of age: effectiveness of endoscopic third ventriculostomy. Eur J Pediatr Surg 19:216–219

    Article  PubMed  CAS  Google Scholar 

  19. Foroughi M, Wong A, Steinbok P, Singhal A, Sargent MA, Cochrane DD (2011) Third ventricular shape: a predictor of endoscopic third ventriculostomy success in pediatric patients. J Neurosurg Pediatr 7:389–396

    Article  PubMed  Google Scholar 

  20. Hu CF, Fan HC, Chang CF, Wang CC, Chen SJ (2011) Successful treatment of Dandy–Walker syndrome by endoscopic third ventriculostomy in a 6-month-old girl with progressive hydrocephalus: a case report and literature review. Pediatr Neonatol 52:42–45

    Article  PubMed  Google Scholar 

  21. Kulkarni AV, Riva-Cambrin J, Browd SR (2011) Use of the ETV Success Score to explain the variation in reported endoscopic third ventriculostomy success rates among published case series of childhood hydrocephalus. J Neurosurg Pediatr 7:143–146

    Article  PubMed  Google Scholar 

  22. Cinalli G, Spennato P, Columbano L, Ruggiero C, Aliberti F, Trischitta V, Buonocore MC, Cianciulli E (2010) Neuroendoscopic treatment of arachnoid cysts of the quadrigeminal cistern: a series of 14 cases. J Neurosurg Pediatr 6:489–497

    Article  PubMed  Google Scholar 

  23. El-Ghandour NM (2011) Endoscopic third ventriculostomy versus ventriculoperitoneal shunt in the treatment of obstructive hydrocephalus due to posterior fossa tumors in children. Childs Nerv Syst 27:117–126

    Article  PubMed  Google Scholar 

  24. Faggin R, Calderone M, Denaro L, Meneghini L, d'Avella D (2011) Long-term operative failure of endoscopic third ventriculostomy in pediatric patients: the role of cine phase-contrast MR imaging. Neurosurg Focus 30:E1

    Article  PubMed  Google Scholar 

  25. Fukuhara T, Vorster SJ, Luciano MG (2000) Risk factors for failure of endoscopic third ventriculostomy for obstructive hydrocephalus. Neurosurgery 46:1100–1109

    Article  PubMed  CAS  Google Scholar 

  26. Takahashi Y (2006) Long-term outcome and neurologic development after endoscopic third ventriculostomy versus shunting during infancy. Childs Nerv Syst 22:1591–1602

    Article  PubMed  Google Scholar 

  27. Naftel RP, Reed GT, Kulkarni AV, Wellons JC (2011) Evaluating the Children's Hospital of Alabama endoscopic third ventriculostomy experience using the Endoscopic Third Ventriculostomy Success Score: an external validation study. J Neurosurg Pediatr 8:494–501

    Article  PubMed  Google Scholar 

  28. Drake JM, Sainte-Rose C (1995) Chapter 5: shunt complications. The shunt book. Blackwell Science, Cambridge, pp 121–192

    Google Scholar 

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The authors declare that they have no conflict of interest.

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Correspondence to M. L. C. van Veelen.

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Fani, L., de Jong, T.H.R., Dammers, R. et al. Endoscopic third ventriculocisternostomy in hydrocephalic children under 2 years of age: appropriate or not? A single-center retrospective cohort study. Childs Nerv Syst 29, 419–423 (2013). https://doi.org/10.1007/s00381-012-1961-z

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  • DOI: https://doi.org/10.1007/s00381-012-1961-z

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