Reimagining durability of hydrocephalus treatment using conditional survival
Aaron M Yengo-Kahn1,2, John C Wellons3, Hailey Jensen4
11Department of Neurosurgery, University of Utah, Salt Lake City, Utah.
Journal of Neurosurgery. Pediatrics
|February 7, 2025
Summary
Patients treated for hydrocephalus have a high chance of remaining revision-free long-term if they avoid surgery in the first year. Conditional survival analysis offers valuable insights for patient counseling.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Medical Statistics
Background:
- Hydrocephalus treatment outcomes require accurate prognostication.
- Conditional survival analysis provides time-dependent survival probabilities.
- Improving patient and family counseling is crucial after hydrocephalus treatment.
Purpose of the Study:
- To analyze conditional survival rates after hydrocephalus treatment.
- To enhance counseling for patients and families regarding long-term outcomes.
- To evaluate survival probabilities for ventriculoperitoneal shunt (VPS) and endoscopic third ventriculostomy (ETV).
Main Methods:
- Analysis of data from the Hydrocephalus Clinical Research Network (HCRN) registry.
- Inclusion of children with hydrocephalus undergoing first-time VPS or ETV with at least 3 years of follow-up.
- Calculation of failure-free survival probabilities at 3, 5, and 10 years as a function of time since surgery.
Main Results:
- Overall 3-, 5-, and 10-year failure-free survival rates were 59%, 58%, 57% for ETV and 62%, 58%, 54% for VPS.
- Post-1-year conditional survival rates significantly improved: 85%, 79%, 66% for VPS and 93%, 91%, 86% for ETV.
- Conditional survival varied by patient age and hydrocephalus etiology.
Conclusions:
- Patients avoiding revision surgery in the first year have excellent long-term revision-free chances.
- Conditional survival plots are intuitive tools for counseling patients with surgically treated hydrocephalus.
- This analysis supports informed decision-making for hydrocephalus management.
