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Endoscopic third ventriculostomy in infants
Michael J Fritsch1, Sven Kienke, Tobias Ankermann
1Department of Neurosurgery, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany. fritschm@nch.uni-kiel.de
Insights
Endoscopic third ventriculostomy (ETV) is effective for infant hydrocephalus, with success depending on the cause, not age. Obstructive hydrocephalus shows a 100% success rate in infants.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Medical Technology
Background:
- Endoscopic third ventriculostomy (ETV) failure rates in infants under one year are reportedly higher than in older children.
- The study investigates ETV outcomes in infants to determine factors influencing success.
Purpose of the Study:
- To evaluate the efficacy of ETV in infants younger than one year for hydrocephalus treatment.
- To ascertain whether patient age or hydrocephalus etiology dictates ETV success.
Main Methods:
- Retrospective review of 18 infant ETVs performed between 1996 and 2002.
- Patients categorized into obstructive hydrocephalus, communicating hydrocephalus, and myelomeningocele-associated hydrocephalus groups.
- Outcomes assessed based on hydrocephalus cause, with a minimum 18-month follow-up.
Main Results:
- No perioperative deaths occurred; transient morbidity was low.
- ETV success rates varied significantly by hydrocephalus cause: 100% for obstructive, 10% for communicating, and 50% for myelomeningocele-associated.
- Obstructive hydrocephalus in infants demonstrated a 100% ETV success rate.
Conclusions:
- ETV is an effective treatment for obstructive hydrocephalus in infants under one year.
- Hydrocephalus etiology, not patient age, is the primary determinant of ETV success and perioperative risk.
- ETV is a viable alternative for treating specific types of infant hydrocephalus.
Object:
The failure rate following endoscopic third ventriculostomy (ETV) in infants younger than 1 year of age has been reported to be higher compared with that of older children. The authors present results of ETVs in such infants and advocate that success or failure of the procedure depends not on the age of the patient but on the cause of the hydrocephalus.
Methods:
The authors retrospectively reviewed the management and outcome of 18 ETVs in infants for the treatment of hydrocephalus. The surgeries were performed between November 1996 and October 2002. The mean age at the time of surgery was 150 days (range 9-354 days). The minimal follow-up period was 18 months and the mean was 50 months. The authors divided the patients into the following three groups: obstructive hydrocephalus (four infants), communicating hydrocephalus (10 infants), and hydrocephalus associated with myelomeningocele (four infants). No perioperative death occurred, and perioperative transient morbidity related to ETV was low. The success of the procedure was determined by the cause of the hydrocephalus. Infants with obstructive hydrocephalus had a 100% success rate (four of four), and infants with communicating hydrocephalus had a 10% success rate (one of 10). In infants with hydrocephalus related to myelomeningocele, the success rate was 50% (two of four).
Conclusions:
The authors conclude that ETV presents an effective alternative for the treatment of obstructive hydrocephalus in infants younger than 1 year of age. Age does not present a contraindication for ETV, nor does it increase the perioperative risk. The success of ETV is determined by the cause of the hydrocephalus.
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