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Author Spotlight: A Single-Entry Point Endoscopic Intraventricular Approach for Third Ventriculostomy and Pineal Biopsy
Published on: June 28, 2024
Role of endoscopic third ventriculostomy in children in a high-burden resource-limited setting: A prospective study
Vaibhav Pandey1, Anutosh Singh2, Ruchira Nandan3
1Department of Pediatric Surgery, IMS-BHU, Varanasi, Uttar Pradesh 221005, India.
Insights
Endoscopic third ventriculostomy (ETV) offers effective shunt-free survival for pediatric hydrocephalus, comparable to international outcomes. Younger age and CSF leaks predict failure, necessitating careful patient selection and technique.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Hydrocephalus Management
Background:
- Endoscopic third ventriculostomy (ETV) is an alternative to ventriculoperitoneal shunting for pediatric hydrocephalus.
- ETV success rates in young children are variable, especially in resource-limited settings.
Purpose of the Study:
- To evaluate the efficacy and safety of ETV in infants and young children (3-60 months) with hydrocephalus.
- To identify predictors of ETV failure in this pediatric population.
Main Methods:
- Prospective observational study of 96 children (3-60 months) undergoing ETV at a tertiary pediatric surgical center in India.
- Analysis of demographics, etiology, intraoperative findings, complications, and 6-month and long-term outcomes (shunt-free survival).
Main Results:
- 72.0% of 82 evaluable patients achieved 6-month ETV success.
- Age < 6 months (54.5% success) and postoperative CSF leak (16.7% incidence, 62.5% requiring shunting) were associated with lower success rates.
- Long-term shunt-free survival plateaued at approximately 74.3% through 5 years.
Conclusions:
- ETV is an effective and durable treatment for hydrocephalus in young children, with outcomes comparable to international data.
- Age under 6 months and postoperative CSF leak are significant predictors of ETV failure.
- Optimizing ETV success in resource-constrained settings requires careful patient selection, meticulous surgical technique, and structured follow-up.
Background:
Endoscopic third ventriculostomy (ETV) is an established alternative to ventriculoperitoneal shunting for pediatric hydrocephalus, but its success in younger children remains variable, particularly in resource-limited settings.
Methods:
We conducted a prospective observational study (July 2019-June 2024) at a tertiary pediatric surgical center in Northern India, including children aged 3-60 months undergoing ETV. Demographics, etiology, intraoperative findings, complications, and outcomes were analyzed. Primary outcome was 6-month ETV success (alive, clinically well, shunt-free). Long-term outcomes were assessed by Kaplan-Meier shunt-free survival analysis.
Results:
Ninety-six children (median age 14 months; 62 % boys) underwent ETV. Fourteen (14.6 %) were excluded from crude 6-month outcomes due to early loss to follow-up. Among 82 evaluable patients, 59 (72.0 %) achieved 6-month success. Success rates by age were: 54.5 % (3-6 months), 66.7 % (6-12 months), 79.5 % (1-2 years), and 70.6 % (2-5 years) (p≈0.11). By etiology, aqueductal stenosis and myelomeningocele had comparable outcomes (70.0 % vs. 77.3 %, p > 0.05). CSF leak occurred in 16.7 % (highest in 6-12 months; p = 0.001), with 62.5 % of these requiring shunting. Other complications included seizures (10.4 %), transient deficits (7.2 %), and infections (4.1 %). Kaplan-Meier analysis showed actuarial shunt-free survival of 74.3 % at 6 months, which plateaued through 5 years. Cine MRI flow studies correlated stoma patency with clinical success.
Conclusion:
ETV provides effective and durable shunt-free survival in young children, with outcomes comparable to international series. Age < 6 months and postoperative CSF leak are key predictors of failure. Careful selection, meticulous technique, and structured follow-up are essential to optimize safety and success in resource-constrained environments.
