Endoscopic third ventriculostomy and repeat endoscopic third ventriculostomy in pediatric patients: the Dutch experience

Dutch Pediatric Neurosurgery Study Group

Research output: Contribution to journalArticlepeer-review

14 Citations (Scopus)

Abstract

OBJECTIVE After endoscopic third ventriculostomy (ETV), some patients develop recurrent symptoms of hydrocephalus. The optimal treatment for these patients is not clear: repeat ETV (re-ETV) or CSF shunting. The goals of the study were to assess the effectiveness of re-ETV relative to initial ETV in pediatric patients and validate the ETV success score (ETVSS) for re-ETV. METHODS Retrospective data of 624 ETV and 93 re-ETV procedures were collected from 6 neurosurgical centers in the Netherlands (1998-2015). Multivariable Cox proportional hazards modeling was used to provide an adjusted estimate of the hazard ratio for re-ETV failure relative to ETV failure. The correlation coefficient between ETVSS and the chance of re-ETV success was calculated using Kendall's tau coefficient. Model discrimination was quantified using the c-statistic. The effects of intraoperative findings and management on re-ETV success were also analyzed. RESULTS The hazard ratio for re-ETV failure relative to ETV failure was 1.23 (95% CI 0.90-1.69; p = 0.20). At 6 months, the success rates for both ETV and re-ETV were 68%. ETVSS was significantly related to the chances of re-ETV success (τ = 0.37; 95% bias corrected and accelerated CI 0.21-0.52; p < 0.001). The c-statistic was 0.74 (95% CI 0.64-0.85). The presence of prepontine arachnoid membranes and use of an external ventricular drain (EVD) were negatively associated with treatment success, with ORs of 4.0 (95% CI 1.5-10.5) and 9.7 (95% CI 3.4-27.8), respectively. CONCLUSIONS Re-ETV seems to be as safe and effective as initial ETV. ETVSS adequately predicts the chance of successful re-ETV. The presence of prepontine arachnoid membranes and the use of EVD negatively influence the chance of success.

Original languageEnglish
Pages (from-to)314-323
Number of pages10
JournalJournal of Neurosurgery. Pediatrics
Volume20
Issue number4
DOIs
Publication statusPublished - Oct 2017
Externally publishedYes

Keywords

  • Adolescent
  • Age Distribution
  • Child
  • Child, Preschool
  • Electronic Health Records/statistics & numerical data
  • Female
  • Follow-Up Studies
  • Humans
  • Hydrocephalus/epidemiology
  • Infant
  • Infant, Newborn
  • Kaplan-Meier Estimate
  • Male
  • Netherlands/epidemiology
  • Neuroendoscopy/methods
  • Proportional Hazards Models
  • Retrospective Studies
  • Third Ventricle/surgery
  • Treatment Outcome
  • Ventriculostomy/methods

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