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Endoscopic third ventriculostomy in children: early and late complications and their avoidance

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Abstract

Introduction

Endoscopic third ventriculostomy (ETV) is considered by many authors the initial surgical procedure of choice for the treatment of non-communicant hydrocephalus. However, this procedure has early and late complications that neurosurgeons must be aware of when performing it.

Materials and results

A retrospective study of infants and children treated with ETV at Children’s Memorial Hospital (Chicago, IL) between 1993 and 2004 is presented. A total of 136 ETVs in 122 patients were performed with 8.8% early complication rate (hemorrhage, CSF leak, infection, diabetes insipidus, and seizures). There were no fatalities but one patient had severe neurological disturbances due to intracranial hemorrhage at the second ETV. We identified several significant factors that influence the late ETV failure rate: age under 12 months (p=0.012), cases performed early in our experience (p=0.009), patients with hydrocephalus without expansive lesions (p=0.026), patients that had an external ventricular drain (EVD) after ETV (p<0.005), and patients who developed early complications (p=0.035).

Conclusion

A careful patient selection and preoperative planning lead to better results of ETV. A higher early and late complication rate in children younger than 1-year-old were noted in our series. There is definitely a learning curve for this technique, and several technical considerations are helpful to avoid adverse events. Most of the early complications are transient, while potential devastating injuries can occur. Long-term follow-up is needed to identify delayed closure of the fenestration. Ventricular access devise is helpful for diagnostic and therapeutic purposes during the follow-up.

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Acknowledgement

We would like to thank Susana Ochoa M.S. from Hospital Sant Joan de Deu Foundation for her thoughtful suggestions and statistical analyses.

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Authors and Affiliations

  1. Division of Pediatric Neurosurgery, Falk Brain Tumor Center, Children’s Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Raul Gil-Parra, Aaron J. Reitman & Tadanori Tomita

  2. Department of Pediatric Neurosurgery, Hospital Sant Joan de Deu, Universitat de Barcelona, Barcelona, Spain

    Ramon Navarro

  3. Division of Pediatric Neurosurgery, Miami Children’s Hospital, University of Miami, Miami, FL, USA

    Greg Olavarria

  4. Department of Neurosurgery, Kansas Unversity Medical School, Kansas, KS, USA

    John A. Grant

Authors
  1. Ramon Navarro
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  2. Raul Gil-Parra
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  3. Aaron J. Reitman
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  4. Greg Olavarria
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  5. John A. Grant
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  6. Tadanori Tomita
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Correspondence to Tadanori Tomita.

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Navarro, R., Gil-Parra, R., Reitman, A.J. et al. Endoscopic third ventriculostomy in children: early and late complications and their avoidance. Childs Nerv Syst 22, 506–513 (2006). https://doi.org/10.1007/s00381-005-0031-1

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  • DOI: https://doi.org/10.1007/s00381-005-0031-1

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