Endoscopic third ventriculostomy in previously shunt-treated patients

Area of Science:

• Neurosurgery
• Pediatric Neurosurgery
• Hydrocephalus Management

Background:

• Endoscopic third ventriculostomy (ETV) is a treatment option for hydrocephalus.
• ETV can be considered for patients with a history of cerebrospinal fluid (CSF) shunt insertion.

Purpose of the Study:

• To evaluate the success rate of postshunt ETV in treating hydrocephalus.
• To identify factors associated with the success or failure of postshunt ETV.
• To report complications associated with postshunt ETV.

Main Methods:

• A multicenter prospective registry (Hydrocephalus Clinical Research Network) was utilized.
• Data from 203 children who underwent ETV between 2008 and 2019 with prior shunt placement were analyzed.
• Kaplan-Meier survival analysis and univariable Cox proportional hazards models were employed.

Main Results:

• The overall success rate of postshunt ETV at 6 months was 41%.
• A clear view of the basilar artery during ETV was the only variable associated with a lower likelihood of failure (HR 0.43).
• Complications were reported in 22% of patients, with CSF leak being the most frequent (8.6%).

Conclusions:

• Postshunt ETV is a viable treatment for hydrocephalus in children with prior shunts, achieving success in 41% of cases.
• Surgical visualization of the basilar artery is a key predictor of successful postshunt ETV.
• While ETV offers an alternative to shunting, its success rate in this population is lower than anticipated, with a notable complication rate.