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Hydrocephalus in infants less than six months of age: effectiveness of endoscopic third ventriculostomy
R Faggin1, A Bernardo, P Stieg
1Department of Pediatric Neurosurgery, University of Padua, Padua, Italy. rfaggin@yahoo.it
Insights
Endoscopic third ventriculostomy (ETV) is effective for infant hydrocephalus, with success rates varying by cause. Etiology, not age, is the key factor for infants under six months.
Area of Science:
- Pediatric Neurosurgery
- Neurology
- Medical Device Technology
Background:
- Endoscopic third ventriculostomy (ETV) is a standard treatment for hydrocephalus.
- Controversy exists regarding ETV success rates in young infants versus older children.
- Defining ETV effectiveness in infants under six months is crucial.
Purpose of the Study:
- To evaluate the effectiveness of ETV for hydrocephalus in infants under six months.
- To identify positive predictive factors for ETV success in this age group.
Main Methods:
- Retrospective analysis of 126 consecutive ETV patients (2000-2002).
- Focus on 21 infants (<6 months) without prior shunting.
- Follow-up duration: 49-82 months.
Main Results:
- Overall ETV success rate was 67% (14/21).
- Failures occurred early post-operatively (average 38 days).
- Success varied by hydrocephalus etiology: best for aqueductal stenosis, Dandy-Walker, myelomeningocele; poorer for post-hemorrhagic/meningitic.
Conclusions:
- Infant age did not correlate with ETV success rates.
- Hydrocephalus etiology is the primary prognostic factor in infants under six months.
- ETV is a viable option, with outcomes dependent on underlying cause.
Objective:
Although endoscopic third ventriculostomy (ETV) is a well established procedure for the treatment of congenital and acquired hydrocephalus, there is still a controversy with regard to the higher risk of failure in younger infants compared to older children after such a procedure. The aim of this article is to define the effectiveness of third ventriculostomy for hydrocephalus in infants less than 6 months of age better and to determine possible positive predictive factors.
Materials And Methods:
In a series of 126 consecutive patients who underwent ETV between January 2000 and December 2002, 21 procedures were performed on infants ranging in age from 23 to 180 days, and without a previous history of shunting. The follow-up period was 49 to 82 months.
Results:
The overall success rate of ETV was 67% (14/21). All failures occurred in the early postoperative period (average 38 days, range 25-88 days). The success rate varied with the etiology of the patient's hydrocephalus. The best results were obtained in patients with acqueductal stenosis, Dandy-Walker malformation and myelomeningocele. The least favorable results (50% failure rate) occurred in infants treated for post-hemorrhagic and post-meningitic hydrocephalus.
Conclusion:
This study does not demonstrate a correlation between the age of the infants and the ETV success rate. The specific etiology of hydrocephalus is the most relevant prognostic factor in infants under six months of age.
