Effectiveness and prognostic factors of endoscopic third ventriculostomy in the treatment of hydrocephalus

Abstract

Objective To investigate the effectiveness and prognostic factors of endoscopic third ventriculostomy(ETV) in the treatment of childhood hydrocephalus. Methods The clinical data of 101 patients with hydrocephalus were retrospectively reviewed, who underwent ETV at Shanghai Children′s Medical Center of Shanghai Jiao Tong University School of Medicine from May 2010 to June 2015.The patient′s ages ranged from l month to 18 years (median age: 29 months). The period of follow-up varied from 6 months to 5 years. The outcomes of ETV and prognostic factors were determined in this study. Results Among the 101 patients, a total of 79 patients achieved satisfactory outcomes and the overall success rate(SR) was 78.2%.The specific SRs were determined to be 96.2% (25/26)and 12/14 in hydrocephalus caused by tumors and arachnoidal cysts, respectively, 75.0% (24/32) for aqueductal stenosis, 5/9 for central never system (CNS) infection, 5/8 forhydrocephalus after neonatal hemorrhage, 6/9 for Chiari malformations and 2/3 for communicating hydrocephalus.There was statistically significant difference between SRs associated with different etiologies (P<0.05). The SR of ETV in children less than 2 year old was 67.3% (31/46) and 89.1% (49/55)for children elder than 2 years, and the difference was statistically significant(P=0.007). Among the 4 patients ultimately submittedfor second ETVs, stoma obstruction was confirmed in 3 cases and constructive hydrocephalus with CSF absorption dysfunction was suggested in the 1 remaining case. Conclusions ETV seems to be an effective and safe procedure in the treatment of childhood hydrocephalus.The patient's age and etiology of hydrocephalus could be related to the success rate. Anatomical variability, stoma obstruction and CSF absorption dysfunctionmight result in ETV failure, a higher chance of which was observed in children under 2 years old and should be taken with caution. Key words: Hydrocephalus; Neuroendoscopy; Child; Endoscopic third ventriculostomy