Breimer et al. report on the results of a large retrospective series of endoscopic third ventriculostomy (ETV) and repeat ETV, with the goal of analyzing the risk of repeat ETV failure compared to primary ETV, based on 624 ETV and 93 re-ETV procedures performed at 6 Dutch centers. ETV failure is defined as the need for subsequent CSF diversion or death related to hydrocephalus. At 6 months followup, a 68% success rate for both ETV and re-ETV was reported. Cox proportional hazards modeling using ETV Success Score (ETVSS) and primary vs. repeat ETV as independent variables revealed no difference between primary and repeat ETV (HR 1.23, 95% CI 0.90-1.69). ETVSS predicted the likelihood of success for primary ETV and re-ETV. Finally, the presence of pre-pontine arachnoid adhesions at the time of re-ETV is associated with higher risk of ETV failure (OR 4.0, 95% CI 1.5-10.5). This retrospective study also did not assess factors a treating surgeon might consider in offering re-ETV, and did not discuss possible impact of choroid plexus cauterization, but these results are useful for surgeons considering re-ETV for children who have failed initial ETV, providing validation of the ETVSS in this population.
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