Endoscopic options in children: experience with 134 procedures.

Area of Science:

• Pediatric Neurosurgery
• Minimally Invasive Surgery
• Hydrocephalus Management

Background:

• Endoscopic procedures are increasingly used in pediatric neurosurgery.
• Endoscopic surgery in children presents unique challenges and varying success rates.

Purpose of the Study:

• To evaluate the safety and efficacy of endoscopic procedures in pediatric neurosurgery.
• To analyze success rates based on lesion type and endoscopic technique in children.

Main Methods:

• A retrospective analysis of 134 endoscopic procedures in 126 pediatric patients (<18 years).
• Procedures included endoscopic third ventriculostomy (ETV), septostomy, aqueductoplasty, and cystocisternostomy for various conditions like brain tumors and cystic lesions.
• Data analyzed for clinical/radiological success, shunt dependence, and influence of patient age.

Main Results:

• Cerebrospinal fluid (CSF) circulation was restored in 72% of patients.
• Endoscopic management of tumor-related hydrocephalus showed an 86% success rate.
• Cyst openings (cystocisternostomy, etc.) had a 77% success rate with no complications, outperforming ETV.
• Endoscopic aqueductoplasty had high failure and complication rates.
• Infants under 6 months had poor outcomes with increased shunt dependence across procedures.

Conclusions:

• Endoscopy is a safe and effective neurosurgical tool for pediatric patients.
• Endoscopic CSF flow restoration is most successful for acute hydrocephalus, particularly tumor-related cases.
• Cyst opening techniques are highly effective with low complication rates.
• Aqueductoplasty should be used judiciously; outcomes are poor in infants <6 months.