• Endoscopic Third Ventriculostomy in the Treatment of Childhood Hydrocephalus

    • Feb 28, 2022

    • Endoscopic third ventriculostomy is an alternative CSF diversion to ventricular shunting with decreased economic cost.
    • ETV has a 30% failure rate in children similar to ventricular shunting (30-40%), however 4-year failure rate is 43% for ETV and 59% for shunts
    • Objective: The authors aimed to develop a predictive model that can accurately predict the probability of ETV success in treating pediatric hydrocephalus based on the child’s individual characteristics.
    • Multi-center, international, retrospective study
    • Study population: 618 consecutive patients that underwent an ETV for hydrocephalus at 12 international institutions in 3 countries (Canada, Israel, and the United Kingdom)
    • Age, etiology, and prior shunt history were significant predictors of ETV success (p-values <.001, 0.7, and .03 respectively)
    • Using 70% training and 30% validation sets, a 6-month ETV success scoring system was created (see graphic)
    • Of note, high operative volume center was tested as a potential independent variable but was not found to be statistically significant.
    • High ETV score (>75) had an 80% success, moderate ETV score (50-75) had a 63% success, and low ETV score (<50) had a 41% success
    • Age ≥ 10 and obstructive pathology (aqueductal stenosis, tectal tumor, other etiology) were associated with largest impact on success (50% and 30%)
    • If ETV is successful at 6-months, the 3- and 5-year success rates are 87% and 83%, respectively
    • Limitations: Some inherent differences in practice patterns may exist within different countries involved. No external validation using data from countries other than the 3 countries involved in the study. The study population had very few patients with certain etiologies such as myelomeningocele and postinfectious hydrocephalus.

     

     

    Source

     

    Reference:

    Journal of Pediatrics

    https://www.jpeds.com/article/S0022-3476(09)00207-8/fulltext

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