Abstract
Purpose
In the current literature, there are essentially no comparisons of quality of life (QOL) outcome after endoscopic third ventriculostomy (ETV) and shunt in childhood hydrocephalus. Our objective was to compare QOL in children with obstructive hydrocephalus, treated with either ETV or shunt.
Methods
A cross-sectional survey was conducted at SickKids, Toronto of children between ages five and 18 years, with obstructive hydrocephalus due to aqueductal obstruction and no other brain abnormalities. Measures of QOL were the Hydrocephalus Outcome Questionnaire and the Health Utilities Index Mark 3. A subset of patients was given the Wechsler Intelligence Scales for Children (WISC-IV).
Results
A total of 47 of 59 (80%) eligible patients participated (24 had ETV as primary treatment, 23 had shunt as primary treatment), with a mean age of 12.1 years (standard deviation 3.9) at assessment. The ETV group was older at initial surgery (p < 0.001) and had larger ventricle size at last follow-up (p = 0.047). In all QOL measures, there were no significant differences between the ETV group and shunt group (all p ≥ 0.09). Treatment failure, hydrocephalus complications, and the presence of a functioning ETV at assessment were not associated with QOL differences. Among the 11 children (six ETV, five shunt) who were given the WISC-IV, there were no significant differences between the scores of the ETV group and shunt group (all p ≥ 0.11).
Conclusions
This is the first study to provide a meaningful comparison of QOL after ETV and shunt in children. These preliminary results suggest that there is no obvious difference in QOL after ETV and shunt.
Similar content being viewed by others
References
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
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
Feeny D, Furlong W, Barr R, Torrance G, Rosenbaum P, Weitzman S (1992) A comprehensive multiattribute system for classifying the health status of survivors of childhood cancer. J Clin Oncol 10:923–928
Feeny D (2000) A utility approach to the assessment of health-related quality of life. Med Care 38(Suppl. II):151–154
Feeny D, Furlong W, Saigal S, Sun J (2004) Comparing directly measured standard gamble scores to HUI2 and HUI3 utility scores: group- and individual-level comparisons. Soc Sci Med 58:799–809
Furlong WJ, Feeny DH, Torrance GW, Barr RD (2001) The Health Utilities Index (HUI) system for assessing health-related quality of life in clinical studies. Ann Med 33:375–384
Garton HJ, Kestle JR, Cochrane DD, Steinbok P (2002) A cost-effectiveness analysis of endoscopic third ventriculostomy. Neurosurgery 51:69–77 discussion 77-68
Jones HC, Klinge PM (2008) Hydrocephalus 2008, 17–20th September, Hannover Germany: a conference report. Cerebrospinal Fluid Res 5:19
Kulkarni AV, Drake JM, Armstrong DC, Dirks PB (1999) Measurement of ventricular size: reliability of the frontal and occipital horn ratio compared to subjective assessment. Pediatr Neurosurg 31:65–70
Kulkarni AV, Drake JM, Rabin D, Dirks PB, Humphreys RP, Rutka JT (2004) An instrument to measure the health status of children with hydrocephalus: the Hydrocephalus Outcome Questionnaire. J Neurosurg 101(2 Suppl Pediatrics):134–140
Kulkarni AV, Drake JM, Rabin D, Dirks PB, Humphreys RP, Rutka JT (2004) Measuring the health status of children with hydrocephalus using a new outcome measure. J Neurosurg 101(2 Suppl Pediatrics):141–146
Kulkarni AV (2006) Distribution-based and anchor-based approaches provided different interpretability estimates for the Hydrocephalus Outcome Questionnaire. J Clin Epidemiol 59:176–184
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
Kulkarni AV, Cochrane DD, McNeely PD, Shams I (2008) Medical, social, and economic factors associated with health-related quality of life in Canadian children with hydrocephalus. J Pediatr 153:689–695
O'Hayon BB, Drake JM, Ossip MG, Tuli S, Clarke M (1998) Frontal and occipital horn ratio: a linear estimate of ventricular size for multiple imaging modalities in pediatric hydrocephalus. Pediatr Neurosurg 29:245–249
Sgouros S, Kulkarni AV, Constantini S (2006) The International Infant Hydrocephalus Study: concept and rationale. Childs Nerv Syst 22:338–345
Takahashi Y (2006) Long-term outcome and neurologic development after endoscopic third ventriculostomy versus shunting during infancy. Childs Nerv Syst 22:1591–1602
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
Author information
Authors and Affiliations
Corresponding author
Additional information
Funding: Funding for this study was provided by SickKids Foundation and Canadian Institutes of Health Research (Institute for Human Development, Child and Youth Health)
Rights and permissions
About this article
Cite this article
Kulkarni, A.V., Hui, S., Shams, I. et al. Quality of life in obstructive hydrocephalus: endoscopic third ventriculostomy compared to cerebrospinal fluid shunt. Childs Nerv Syst 26, 75–79 (2010). https://doi.org/10.1007/s00381-009-0983-7
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00381-009-0983-7