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Reproductive implications of endoscopic third ventriculostomy for the treatment of hydrocephalus
Mohamed A Bedaiwy1, Mohamed M Fathalla, Omar M Shaaban
1Department of Obstetrics and Gynecology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA.
Objective:
The objective of this study was to compare reproductive function after two neurosurgical procedures for treating non-neoplastic hydrocephalus; endoscopic third ventriculostomy (ETV) and ventriculo-peritoneal shunt (VP).
Study Design:
A cohort of 96 women who underwent neurosurgical procedures to treat non-neoplastic hydrocephalus at the Cleveland Clinic between January 1995 and January 2004 was identified. A follow up mailed survey was sent to all identified women between 15 and 45 years of age. In addition, phone interviews were performed to complete the required data. Clinical, laboratory and operative details were collected from 69 participants.
Results:
There was a two-fold significant increase in the menstrual irregularities after the procedure in the ETV group [5/52(10%)-10/52(19%), P=0.03] while those treated with VP shunt maintained the same menstrual pattern postoperatively. The rate of pregnancy was higher in the VP group compared to the ETV group, but did not reach statistical significance [8/17(47%) vs. 17/52(33%), P=0.462]. Similarly, the rate of term pregnancies was higher in the VP group compared to ETV group [8/8(100%) vs. 13/17(76%), P=0.269], which reflected a higher spontaneous miscarriage rate in ETV compared to VP group [4/17(33%) vs. 0/8(0%), P=0.269].
Conclusion:
ETV appears to alter reproductive function postoperatively. In patients who establish a pregnancy, abortion rates seem to be higher in the ETV group; however, a prospective study will be required to validate these observations.
