Long-term follow-up of endoscopic third ventriculostomy performed in the pediatric population

Long-term follow-up of endoscopic third ventriculostomy performed in the pediatric population

Journal of Neurosurgery: PediatricsJun 2016 / Vol. 17 / No. 6 / Pages 734-738

1Department of Neurosurgery, Royal Liverpool Children’s Hospital; 2Department of Neurosurgery, The Walton Centre for Neurology and Neurosurgery, Liverpool; and 3Department of Neurosurgery, University Hospital Wales, Heath Park, Cardiff, United Kingdom
ABBREVIATIONS ETV = endoscopic third ventriculostomy; ETVSS = ETV Success Score; VP = ventriculoperitoneal.

INCLUDE WHEN CITING Published online February 12, 2016; DOI: 10.3171/2015.11.PEDS15212.

Correspondence Matthew G. Stovell, Department of Academic Neurosurgery, Addenbrooke’s Hospital, Lower Ln., Cambridge CB2 0QQ, United Kingdom. email: .
Related Articles
By Keywords:
hydrocephalus,ETV, long term, follow-up, CSF disorders

Abstract

OBJECTIVE

Endoscopic third ventriculostomy (ETV) is an effective treatment for obstructive hydrocephalus and avoids the risk for foreign-body infection associated with ventriculoperitoneal (VP) shunts. The short-term failure rate of ETV strongly depends on the indications for its use but is generally thought to be lower in the long term than that of VP shunts. However, few studies are available with long-term follow-up data of ETV for hydrocephalus in children. The authors reviewed the long-term success of ETV at their institution to investigate the rate of any late failures of this procedure.

METHODS

Between April 1998 and June 2006, 113 children (including neonates and children up to 16 years old) had primary or secondary ETV for different causes of hydrocephalus. The patients’ medical records and the authors’ electronic operation database were reviewed for evidence of additional surgery (i.e., repeat ETV or VP shunt insertion). These records were checked at both the pediatric and adult neurosurgical hospitals for those patients who had their care transferred to adult services.

RESULTS

The median length of follow-up was 8.25 years (range 1 month to 16 years). Long-term follow-up data for 96 patients were available, 47 (49%) of whom had additional ETV or VP shunt insertion for ETV failure. Twenty patients (21%) had a second procedure within 1 month, 17 patients (18%) between 1 and 12 months, 7 patients (7%) between 1 and 5 years, and 3 patients (3%) between 5 and 8 years.

CONCLUSIONS

In the authors’ series, ETV had an initial early failure rate for the treatment of pediatric hydrocephalus as reported previously, and this rate significantly depended on patient age and hydrocephalus etiology. Once stabilized and effective, ETV appeared to be durable but not guaranteed, and some late decline in effectiveness was observed, with some ETV failures occurring many years later. Thus, successful ETV in children cannot be guaranteed for life, and some form of follow-up is recommended long term into adulthood.

READ MORE: http://thejns.org/doi/abs/10.3171/2015.11.PEDS15212 

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