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Endoscopic third ventriculostomy for hydrocephalus in children younger than 1 year of age
Essam A Elgamal1, Abdel-Azim El-Dawlatly, Waleed R Murshid
1Neurosurgery Division, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia. eelgamal@hotmail.com
Insights
Endoscopic third ventriculostomy (ETV) is a viable alternative to ventriculoperitoneal shunts for infant hydrocephalus, particularly in cases of occlusive hydrocephalus. Success rates vary by etiology and gestational age, with preterm infants showing poorer outcomes.
Area of Science:
- Pediatric Neurosurgery
- Hydrocephalus Management
- Minimally Invasive Surgery
Background:
- Hydrocephalus is a common condition in infants, often requiring surgical intervention.
- Traditional treatment involves ventriculoperitoneal shunts (VPS), which have associated complication rates.
- Endoscopic third ventriculostomy (ETV) offers a less invasive alternative for certain types of hydrocephalus.
Purpose of the Study:
- To evaluate the efficacy and safety of endoscopic third ventriculostomy (ETV) in infants under one year of age.
- To assess the role of ETV as an alternative to ventriculoperitoneal shunts (VPS) in pediatric hydrocephalus.
- To identify factors influencing ETV success in this population.
Main Methods:
- Retrospective analysis of 52 ETV procedures performed between 1995 and 2008 in 49 infants.
- Patients' ages ranged from 6 days to 12 months.
- Hydrocephalus etiologies included occlusive (aqueduct stenosis, Chiari II, Dandy-Walker) and communicating (post-hemorrhage, post-meningitis).
Main Results:
- Overall ETV success rate was 69.4% with a mean follow-up of 68.2 months.
- Higher success rates (77.4%) were observed in patients with aqueduct stenosis.
- Preterm infants had significantly poorer outcomes, with 6 out of 7 requiring permanent VPS.
Conclusions:
- ETV is a potential alternative to VPS for occlusive hydrocephalus in infants.
- ETV efficacy is dependent on both age and etiology, performing better in full-term infants with occlusive hydrocephalus.
- ETV can be considered for infants with shunt failure after VPS placement.
Objective:
The purpose of this study is to assess the role of endoscopic third ventriculostomy (ETV) in the treatment of hydrocephalus in children under 1 year of age. The authors analyzed data of ETV in their institution.
Methods:
Between January 1995 and December 2008, 52 ETV procedures were performed for the treatment of hydrocephalus in 49 infants (32 male and 17 female). Their age ranged from 6 days to just under 12 months (mean age 6.2 months). The cause of hydrocephalus was occlusive in 43 patients (aqueduct stenosis in 31, Chiari II malformation in eight, Dandy-Walker cyst in two, quadrigeminal lipoma in one, and cerebellopontine angle arachnoid cyst in one patient). Communicating hydrocephalus was caused by intraventricular hemorrhage, meningitis, and/or ventriculitis in six patients.
Results:
The overall success rate was 69.4% with mean follow-up period of 68.2 months. Patients with aqueduct stenosis had a higher success rate of ETV which was 77.4%. Seven infants were born preterm, six of them required a permanent ventriculoperitoneal shunts (VPS; P = 0.003). Malfunctioned VPS was removed in two patients following ETV. There was one death from intracranial hemorrhage, two cerebrospinal fluid leaks, and one meningitis.
Conclusion:
Endoscopic third ventriculostomy can be considered a possible treatment procedure alternative to VPS for the treatment of occlusive hydrocephalus in infants. ETV was effective in full-term infants while the results in low birth weight, preterm infants were poor. Success of ETV is not only age dependent but also etiology dependent. Infants with occlusive hydrocephalus treated with VPS, who present with shunt failure, could be treated by ETV and removal of the shunt device.
