Abstract
Purpose
Post-operative seizure rates after endoscopic third ventriculostomy (ETV) are not definitively known. We analyzed our institution’s experience for all causes of hydrocephalus in pediatric patients undergoing ETV to determine rates of post-ETV seizure.
Methods
A retrospective review of institutional pediatric patients undergoing ETV from May 2014 to December 2018. Included were < 21 years, with 1-year follow-up. Exclusion criteria included ventriculoperitoneal shunts (VPS) prior to ETV, VPS within 7 days post-ETV, and prior seizure disorder. Data included age, gender, diagnosis, early post-operative seizure (within 7 days post-ETV), late post-operative seizures (after first 7 days and within first year post-ETV), concomitant choroid plexus cauterization (CPC), VPS conversion within 1 year, and administration of prophylactic antiepileptics.
Results
Sixty of 81 ETV cases were included; 41% underwent concomitant CPC. Of these, 53% (n = 32) were male, 46% (n = 28) female, averaging 5.8 years, with the most common diagnosis neoplasm-related obstructive hydrocephalus (38.3%, n = 23). Early post-operative seizure occurred in 6.7% (n = 4); late post-operative seizure occurred in 8.3% (n = 5). Late post-operative seizures were higher in patients experiencing early post-operative seizure versus those without (75% vs 3.7%, p = 0.003). Late post-operative seizure occurred in 13.6% (n = 3 patients) requiring VPS versus 5.3% (n = 2 patients) with successful ETV (p = 0.36). Rates did not correlate with pathology. No patients received prophylactic antiepileptics prior to surgery or exhibiting a seizure.
Conclusions
Patients with early post-operative seizures have an increased likelihood of developing late post-operative seizures. Pediatric ETV patients may have a lower rate of both early and late post-operative seizure; underlying pathology may influence these rates.
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Abbreviations
- CSF:
-
Cerebrospinal fluid
- CPC:
-
Choroid plexus cauterization
- EEG:
-
Electroencephalogram
- ETV:
-
Endoscopic third ventriculostomy
- VPS:
-
Ventriculoperitoneal shunts
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The authors appreciate the assistance of Sharon Durfy, PhD, with manuscript preparation.
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Dr. Hauptman reports he is a consultant for Medtronic, unrelated to work described in this research. All other authors report no conflict of interest.
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This study was accepted for an International Society of Pediatric Neurosurgery Poster/Talk.
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Barkley, A.S., Boop, S., Barber, J.K. et al. Post-operative seizure after first time endoscopic third ventriculostomy in pediatric patients. Childs Nerv Syst 37, 1871–1875 (2021). https://doi.org/10.1007/s00381-021-05078-y
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DOI: https://doi.org/10.1007/s00381-021-05078-y