Abstract
PurposeAge and etiology play a crucial role in success of endoscopic third ventriculostomy (ETV) as a treatment of obstructive hydrocephalus. Outcome is worse in infants, and controversies still exist whether ETV is superior to shunt placement. We retrospectively analyzed 70 patients below 2 years from 4 different centers treated with ETV and assessed success.MethodsChildren < 2 years who received an ETV within 1994–2018 were included. Patients were classified according to age and etiology; < 3, 4–12, and 13–24 months, etiologically; aqueductal stenosis, post-hemorrhagic-hydrocephalus (PHH), tumor-related, fourth ventricle outflow obstruction, with Chiari-type II and following CSF infection. We investigated statistically the predictors for ETV success through computing Kaplan-Meier estimates using patient’s follow-up time and time to ETV failure.ResultsWe collected 70 patients. ETV success rate was 41.4%. The highest rate was in tumor-related hydrocephalus and fourth ventricle outlet obstruction (62.5%, 60%) and the lowest rate was in Chiari-type II and following infection (16.7%, 0%). The below 3 months age group showed relatively lower success rate (33.3%) in comparison to older groups which showed similar results (46.4%, 46.6%). Statistically, a previous VP shunt was a predictor for failure (p value < 0.05).ConclusionFactors suggesting a high possibility of failure were age < 3 months and etiology such as Chiari-type II or following infection. Altered CSF dynamics in patients with PHH and under-developed arachnoid villi may play a role in ETV failure. We do not recommend ETV as first line in children < 3 months of age or in case of Chiari II or following infection.
Highlights
Lund University, Lund, Sweden 7 Department of Neurosurgery, Cairo University, Cairo, EgyptThe optimal treatment for hydrocephalus in infants is still not definitively determined [1,2,3,4,5,6,7]
We report on the success rate of endoscopic third ventriculostomy (ETV) in infants below 2 years of age through our combined experience from 4 university centers
25 patients suffered from idiopathic aqueductal stenosis (35.7%), 22 from PHH (31.4%), 8 from tumor-related hydrocephalus (11.4%), 5 from fourth ventricle outlet obstruction (7.1%), 6 from Chiari malformation-type II with myelomeningocele (8.6%), and 4 from post-infection hydrocephalus (5.7%)
Summary
The optimal treatment for hydrocephalus in infants is still not definitively determined [1,2,3,4,5,6,7]. Despite the advances that have been achieved recently in the field of neuroendoscopy and shunt hardware, the treatment of hydrocephalus in infants remains one of the most difficult and challenging situations faced by neurosurgeons. Age, etiology, and experience of the surgeon are important factors that determine success and complication rates of ETV [9]. Higher success rates, reaching 90%, in some studies have been reported in infants with aqueductal stenosis [10,11,12,13,14,15,16].
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