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Published on: June 28, 2024
Endoscopic third ventriculostomy in children with chronic communicating congenital hydrocephalus: a single-center
Laura Baeza-Antón1, María Isabel Martínez-León2, Bienvenido Ros-López3
1Department of Neurosurgery, HGU Doctor Negrín, Las Palmas de Gran Canaria, Spain. laubaeza1221@gmail.com.
Insights
Endoscopic third ventriculostomy (ETV) shows promise for treating pediatric chronic communicating congenital hydrocephalus (CCCH). Most patients experienced clinical improvement and reduced ventricular size, with a low rate of shunt placement.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Medical Imaging
Background:
- Chronic communicating congenital hydrocephalus (CCCH) in children presents significant management challenges.
- Endoscopic third ventriculostomy (ETV) is a minimally invasive surgical option for hydrocephalus.
- The efficacy of ETV in pediatric CCCH requires further investigation.
Purpose of the Study:
- To evaluate the effectiveness and outcomes of endoscopic third ventriculostomy (ETV) in treating pediatric chronic communicating congenital hydrocephalus (CCCH).
- To analyze radiological changes and clinical evolution following ETV in pediatric CCCH patients.
Main Methods:
- Retrospective analysis of 11 pediatric patients with CCCH treated with ETV.
- Data collection included clinical parameters, surgical complications, and follow-up outcomes.
- Magnetic resonance imaging (MRI) was used to assess ventricular indexes before and after ETV.
Main Results:
- ETV demonstrated success in most patients, with clinical improvement and reduced ventricular indexes on MRI.
- Three out of 11 patients required subsequent shunt placement, with one early failure in an infant.
- Mean ETV survival was 32.1 months in successful cases and 16 months in failed cases.
Conclusions:
- Endoscopic third ventriculostomy (ETV) is a potentially effective treatment for pediatric chronic communicating congenital hydrocephalus (CCCH).
- Further studies with larger cohorts are warranted to confirm these findings.
- ETV offers a promising alternative to shunting in select pediatric CCCH cases.
Objective:
The aim of this study was to analyze the role of endoscopic third ventriculostomy (ETV) in the treatment of pediatric chronic communicating congenital hydrocephalus (CCCH).
Material And Methods:
This retrospective study comprised a series of 11 children with CCCH treated with ETV. Data were recorded on gender, history, presenting symptoms, age at surgery, complications during surgery, clinical evolution, ETV survival, and follow-up period. Radiological variables including ventricular and cephalic diameters were also recorded to determine a series of ventricular indexes in magnetic resonance imaging (MRI) before and after the ETV procedure. The procedure was considered to be successful when there was clinical stability or improvement accompanied by a reduction in the radiological indexes in the postoperative control images, such that there was no need to place an extrathecal cerebrospinal fluid shunt.
Results:
Over a mean follow-up period of 35.8 months (range: 6-108 months) from the ETV procedure, three patients required shunt placement; one of these was due to early failure in an 8-month old girl, the only patient younger than 12 months in our series. The radiological indexes were reduced in all patients except for one of the cases of ETV failure. The mean ETV survival among the successful cases was 32.1 months (range: 6-108 months), whilst that of the failed cases was 16 months (range: 6-108 months).
Conclusion:
Although studies with larger sample sizes are needed, ETV appears to be a promising option for the treatment of this type of patient with CCCH.
