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Endoscopic third ventriculostomy in children younger than 2 years of age
Jörg Baldauf1, J Oertel, Michael R Gaab
1Department of Neurosurgery, Ernst-Moritz-Arndt University, Sauerbruchstrasse, 17475, Greifswald, Germany.
Insights
Endoscopic third ventriculostomy (ETV) is a controversial treatment for pediatric hydrocephalus. This study found a 43% success rate in children under two, with better outcomes for idiopathic aqueductal stenosis.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Medical Technology
Background:
- Endoscopic third ventriculostomy (ETV) is a debated treatment for pediatric hydrocephalus.
- Success rates of ETV in children under two years old require further analysis.
Purpose of the Study:
- To analyze the success rate of ETV in treating hydrocephalus in patients younger than 2 years.
- To determine factors influencing ETV success in this pediatric population.
Main Methods:
- A series of 21 pediatric patients (16 under 1 year) with hydrocephalus underwent ETV.
- Hydrocephalus etiologies included idiopathic aqueductal stenosis, congenital anomalies, posthemorrhagic, and tumor-related occlusive hydrocephalus.
- ETV success was defined as avoiding the need for shunting.
Main Results:
- The overall success rate for ETV was 43% (9 out of 21 patients), with a mean follow-up of 26.2 months.
- ETV was successful in 37.5% of patients younger than 1 year.
- Success rates varied by etiology, with idiopathic aqueductal stenosis showing more favorable outcomes.
Conclusions:
- ETV success in children under two with non-communicating hydrocephalus depends on age and etiology.
- The overall success rate was 43%, with 37.5% success in infants under one year.
- ETV appears more beneficial for hydrocephalus due to idiopathic aqueductal stenosis compared to other causes.
Introduction:
Endoscopic third ventriculostomy (ETV) for the treatment of hydrocephalus of different etiologies is still controversial in children younger than 2 years of age. The success rate of ETV in this group of patients is analyzed in this study.
Materials And Methods:
The series consisted of 21 patients treated with ETV. The mean age of the patients was 6.7 months, ranging from 9 days to 15 months (16 patients were younger than 1 year). The study included hydrocephalus due to idiopathic aqueductal stenosis (eight) and other congenital anomalies (four) as well as posthemorrhagic (three) and tumor-related occlusive hydrocephalus (three). Two patients presented with shunt infection and one with a shunt failure. ETV was considered to be successful when shunting could be avoided.
Results:
ETV was successful in nine patients, with a mean follow-up period of 26.2 months. The procedure was successful in four patients with idiopathic aqueductal stenosis, in two with other congenital anomalies, in one posthemorrhagic, and in two with a tumor-related hydrocephalus. In 12 patients, the ETV was unsuccessful after a mean follow-up of 3.3 months. These patients required a shunt. Ten of them were less than 1 year old when ETV was performed. In one tumor-related hydrocephalus, a shunt was inserted after a meningitis after tumor removal.
Conclusions:
The success of ETV in children younger than 2 years of age suffering from non-communicating hydrocephalus seems to be dependent on both age and etiology. Our results show an overall success rate of 43%. In 37.5% of the children younger than 1 year of age, ETV was successful. ETV in patients with hydrocephalus due to idiopathic aqueductal stenosis seems to be more beneficial than in other causes of hydrocephalus.
