Factors affecting surgical outcome of endoscopic third ventriculostomy in congenital hydrocephalus |
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| Affiliation: | 1. Department of Neurosurgery, University of California San Francisco, 505 Parnassus Avenue, M 779, San Francisco, CA 94143-0112, USA;2. Department of Radiation Oncology, University of California San Francisco, CA, USA;1. Department of Neurological Surgery, University of California at San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-0112, USA;2. Department of Pathology, University of California at San Francisco, San Francisco, CA, USA;3. Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA;1. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China;2. Clinical Medical Examination, The Sixth People Hospital of Jinan, Shandong, China;3. School of Public Health and Family Medicine, Capital Medical University, Beijing, China;4. Beijing Neurosurgical Institute, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing 100050, China;1. Department of Neurological Surgery, Massachusetts General Hospital & Harvard Medical School, 55 Fruit Street, White Building Room 502, Boston, MA 02114, USA;2. Department of Neurosurgery, Brigham and Women’s Hospital & Harvard Medical School, Boston, MA, USA;3. Department of Radiology, Brigham and Women’s Hospital & Harvard Medical School, Boston, MA, USA;4. Department of Neurosurgery, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA, USA;5. Department of Radiology, New England Center for Stroke Research, University of Massachusetts, Worcester, MA, USA |
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| Abstract: | Endoscopic third ventriculostomy (ETV) is an accepted modality of treatment for obstructive hydrocephalus, with good results in adult patients. However in the pediatric age group results vary from poor to similar to the adult population. This study evaluates the outcome of ETV in congenital hydrocephalus of both early and delayed presentation, and investigates factors that determine the outcome. Patients with congenital hydrocephalus who underwent ETV between January 2006 and December 2011 were retrospectively analyzed. Any conditions potentially influencing the need for redo surgery (persistent cerebrospinal fluid [CSF] leak not responding to local measures, tense fontanelle, increased ventricular size, recurrence of symptoms or radiological evidence of failure) were analyzed. A total of 102 patients with a mean age of 7.45 years were included. Presenting features were increasing head circumference and delayed milestones. Ninety-eight patients had triventricular hydrocephalus due to aqueductal stenosis. Procedures performed were ETV only (n = 74), ETV with aqueductoplasty (n = 22), ETV with cystoventriculostomy (n = 2) and aqueductoplasty only (n = 2). Failure of ETV occurred in 11 patients and all were managed with a ventriculoperitoneal shunt. CSF leak in the perioperative period was the only factor that was significantly associated with failure of ETV. ETV is a safe procedure with a good success rate and can be offered to children with aqueductal stenosis. There is a higher chance of failure if there is a CSF leak in the early or late postoperative period. |
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| Keywords: | Aqueductal stenosis Congenital Endoscopic third ventriculostomy Hydrocephalus |
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