Clinical StudyTiming of endoscopic third ventriculostomy in pediatric patients with congenital obstructive hydrocephalus: assessment of neurodevelopmental outcome and short-term operative success rate
Introduction
After Jason Mixters performed an endoscopic third ventriculostomy (ETV) for the first time in 1923, the procedure became an option for treating occlusive hydrocephalus of various origins. During the past decades, it has been widely used on pediatric patients with aqueduct stenosis in many centers because of its advantage of providing a natural route for cerebrospinal fluid (CSF) flow within the range of indications. The long-term success rate has been reported to be as high as 80% [1], [2], [3], [4], however, according to some reports on ETV, children younger than 6 months have a lower success rate of 12.5% [6]. Furthermore, several studies have indicated that age at the time of ETV is the most important independent risk factor for surgical effectiveness and long-term functional outcome [5]. More recent evidence from a larger, multicenter series supported the finding that age was the main determinant for outcome in younger children, particularly neonates [20], [24], [25]. Due to the high failure and complication rates of ETV, severe neurodevelopmental sequelae and poor quality of life of these children, ETV has been preformed on a highly selective basis. Therefore, determining suitable candidates for ETV was difficult, but important [7].
Little is known about long term outcome in pediatric patients with hydrocephalus, particularly neurodevelopmental outcomes and health-related quality of life. The effectiveness of ETV should not merely be measured by morbidity rate. In this study, we investigated the success of ETV and the postoperative neurodevelopmental outcome of 63 consecutive children who underwent initial ETV at different ages for the treatment of congenital obstructive hydrocephalus.
Section snippets
Patients
A total of 459 pediatric patients enrolled between January 2010 and January 2014 underwent primary ETV for the treatment of congenital obstructive hydrocephalus (aqueduct stenosis) and 63 fulfilled the highly selective inclusion criteria. The exclusion criteria were previous history of supra- or infratentorial tumor, myelomeningocele, intracranial infection, intracranial cyst, intraventricular hemorrhage, Chiari malformation, Dandy–Walker syndrome, trauma, or bone marrow or blood diseases.
Results
ETV was initially performed in 63 children who were diagnosed for the first time with obstructive hydrocephalus due to congenital aqueduct stenosis. The children were under 18 months of age (median 7.8 months; range: 3.3–18) with no previous history of neurosurgical interventions (external ventricular drainage or VPS). All selected children were categorized into three groups according to whether they underwent early (age ⩽ 6 months), midterm (6 < age ⩽ 12 months) or late (age > 12 months) ETV. In addition,
Discussion
In this study, we investigated the success rate of ETV as a primary treatment for congenital obstructive hydrocephalus caused by aqueduct stenosis in pediatric patients with no previous history of ETV or VPS. Health-related quality of life for children with hydrocephalus is of concern for many researchers, however, few studies focus on the impact of ETV treatment on neurodevelopmental outcome in children. Therefore, we assessed pre- and postoperative neurodevelopmental status by means of GDDS.
Conclusion
Our study confirmed that age at the time of surgery was a significant risk factor for both operative success rate and functional outcome. Although children achieved improvement of outcome to some extent after ETV, overall prognosis was not optimistic.
Conflicts of Interest/Disclosures
The authors declare that they have no financial or other conflicts of interest in relation to this research and its publication.
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