Skip to main content

Advertisement

SpringerLink
Log in

Successful endoscopic third ventriculostomy in children depends on age and etiology of hydrocephalus: outcome analysis in 51 pediatric patients

  • Original Paper
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Purpose

Endoscopic third ventriculostomy (ETV) has become the method of choice in the treatment of hydrocephalus. Age and etiology could determine success rates (SR) of ETV. The purpose of this study is to assess these factors in pediatric population.

Methods

Retrospective study on 51 children with obstructive hydrocephalus that underwent ETV was performed. The patients were divided into three groups per their age at the time of the treatment: < 6, 6–24, and > 24 months of age. All ETV procedures were performed by the same neurosurgeon.

Results

Overall SR of ETV was 80% (40/51) for all etiologies and ages. In patients < 6 months of age SR was 56.2% (9/16), while 6–24 months of age was 88.9% (16/18) and > 24 months was 94.1% (16/17) (p = 0.012). The highest SR was obtained on aqueductal stenosis. SR of posthemorrhagic, postinfectious, and spina bifida related hydrocephalus was 60% (3/5), 50% (1/2), and 14.3% (1/7), respectively. While SR rate at the first ETV attempt was 85.3%, it was 76.9% in patients with V-P shunt performed previously (p = 0.000).

Conclusions

Factors indicating a potential failure of ETV were young age and etiology such as spina bifida, other than isolated aqueductal stenosis. ETV is the method of choice even in patients with former shunting. Fast healing, distensible skulls, and lower pressure gradient in younger children, all can play a role in ETV failure. Based on our experience, ETV could be the first method of choice for hydrocephalus even in children younger than 6 months of age.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9

Similar content being viewed by others

References

  1. Baldauf J, Oertel J, Gaab MR, Schroeder HWS (2007) Endoscopic third ventriculostomy in children younger than 2 years of age. Childs Nerv Syst 23:623–626

    Article  PubMed  Google Scholar 

  2. Balthasar AJ, Kort H, Cornips EM, Beuls EA, Weber JW, Vles JS (2007) Analysis of the success and failure of endoscopic third ventriculostomy in infants less than 1 year of age. Childs Nerv Syst 23:151–155

    Article  PubMed  CAS  Google Scholar 

  3. Bargalló N, Olondo L, Garcia AI, Capurro S, Caral L, Rumia J (2005) Functional analysis of third ventriculostomy patency by quantification of CSF stroke volume by using cine phase-contrast imaging. Am J Neuroradiol 26:2514–2521

    PubMed  Google Scholar 

  4. Beems T, Grotenhuis JA (2002) Is the success of endoscopic third ventriculostomy age-dependent? An analysis of the results of endoscopic third ventriculostomy in children. Childs Nerv Syst 18:605–608

    Article  PubMed  Google Scholar 

  5. Bognar L, Markia B (2005) Retrospective analysis of 400 neuroendoscopic interventions: the Hungarian experience. Neurosurg Focus 19:E10

    Article  PubMed  Google Scholar 

  6. Brichtova E, Chlachula M, Hrbac T, Lipina R (2013) Endoscopic third ventriculostomy in previously shunted children, Minim Invasive Surg 584567, 4 pages

  7. Brockmeyer D, Abtin K, Carey L, Walker ML (1998) Endoscopic third ventriculostomy: an outcome analysis. Pediatr Neurosurg 28(5):236–240

    Article  PubMed  CAS  Google Scholar 

  8. Buxton A, Macarthur D, Mallucci C, Punt J, Vloeberghs M (1998) Neuroendoscopy in the premature population. Childs Nerv Syst 14:649–652

    Article  PubMed  CAS  Google Scholar 

  9. Buxton N, Macarthur D, Mallucci C, Punt J, Vioeberghs M (1998) Neuroendoscopic third ventriculostomy in patients less than 1 year old. Pediatr Neurosurg 29:73–76

    Article  PubMed  CAS  Google Scholar 

  10. Chi JH, Fullerton HJ, Gupta N (2005) Time trends and demographics of deaths from congenital hydrocephalus in the United States: National Center for Health Statistics data, 1979 to 1998. J Neurosurg 103:113–118

    PubMed  Google Scholar 

  11. Cinalli G, Sainte-Rose C, Chumas P, Zerah M, Brunelle F, Lot G, Pierre-Kahn A, Renier D (1999) Failure of third ventriculostomy in the treatment of aqueductal stenosis in children. J Neurosurg 90:448–454

    Article  PubMed  CAS  Google Scholar 

  12. Constantini S, Sgouros S, Kulkarni A (2013) Neuroendoscopy in the youngest age group. World Neurosurg 79(2 Suppl):S23

    PubMed  Google Scholar 

  13. Durnford AJ, Kirkham FJ, Mathad N, Sparrow OC (2011) Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus: validation of a success score that predicts long-term outcome. J Neurosurg Pediatr 8:489–493

    Article  PubMed  Google Scholar 

  14. Etus V, Ceylan S (2005) Success of endoscopic third ventriculostomy in children less than 2 years of age. Neurosurg Rev 28:284–288

    Article  PubMed  Google Scholar 

  15. Fritsch MJ, Kienke S, Ankermann T, Padoin M, Mehdorn HM (2005) Endoscopic third ventriculostomy in infants. J Neurosurg 103:50–53

    PubMed  Google Scholar 

  16. Fukuhara T, Vorster SJ, Luciano MG (2000) Risk factors for failure of endoscopic third ventriculostomy for obstructive hydrocephalus. Neurosurgery 46(5):1100–1109 discussion 1109-11

    Article  PubMed  CAS  Google Scholar 

  17. Furlanetti LL, Santos MV, Santos de Oliveira R (2012) The success of endoscopic third ventriculostomy in children: analysis of prognostic factors. Pediatr Neurosurg 48:352–359

    Article  PubMed  Google Scholar 

  18. Gallo P, Szathmari A, Biasi SD, Carmine M (2010) Endoscopic third ventriculostomy in obstructive infantile hydrocephalus: remarks about the so-called ‘unsuccessful cases’. Pediatr Neurosurg 46:435–441

    Article  PubMed  Google Scholar 

  19. Gangemi M, Donati P, Maiuri F, Longatti P, Godano U, Mascari C (1999) Endoscopic third ventriculostomy for hydrocephalus. Minim Invasive Neurosurg 42:128–132

    Article  PubMed  CAS  Google Scholar 

  20. Gorayeb RP, Cavalheiro S, Zymberg ST (2004) Endoscopic third ventriculostomy in children younger than 1 year of age. J Neurosurg 100:427–429

    PubMed  Google Scholar 

  21. Hader WJ, Walker RL, Myles ST, Hamilton M (2008) Complications of endoscopic third ventriculostomy in previously shunted patients. Neurosurgery 63(suppl 1):168–174

    Google Scholar 

  22. Hopf NJ, Grunert P, Fries G, Resch KD, Perneczky A (1999) Endoscopic third ventriculostomy: outcome analysis of 100 consecutive procedures. Neurosurgery 44:795–806

    Article  PubMed  CAS  Google Scholar 

  23. Jones RF, Kwok BC, Stening WA, Vonau M (1994) The current status of endoscopic third ventriculostomy in the management of non-communicating hydrocephalus. Minim Invasive Neurosurg 37(1):28–36

    Article  PubMed  CAS  Google Scholar 

  24. Jones RF, Kwok BC, Stening WA, Vonau M (1994) Neuroendoscopic third ventriculostomy. A practical alternative to extracranial shunts in non-communicating hydrocephalus. Acta Neurochir Suppl 61:79–83

    PubMed  CAS  Google Scholar 

  25. Jones RF, Kwok BC, Stening WA, Vonau M (1996) Third ventriculostomy for hydrocephalus associated with spinal dysraphism: indications and contraindications. Eur J Pediatr Surg 6:5–6

    Article  PubMed  Google Scholar 

  26. Kadrian D, vanGelder J, Florida D, Jones R, Vonau M, Teo C, Stening W, Kwok B (2008) Long-term reliability of endoscopic third ventriculostomy. Neurosurgery 62(Suppl 2):614–621

    PubMed  Google Scholar 

  27. Kim SK, Wang KC, Cho BK (2000) Surgical outcome of pediatric hydrocephalus treated by endoscopic III ventriculostomy: prognostic factors and interpretation of postoperative neuroimaging. Childs Nerv Syst 16:161–169

    Article  PubMed  CAS  Google Scholar 

  28. Koch D, Wagner W (2004) Endoscopic third ventriculostomy in infants of less 1 year of age: which factors influence the outcome? Childs Nerv Syst 20:405–411

    Article  PubMed  Google Scholar 

  29. Koch-Wiewrodt D, Wagner W (2006) Success and failure of endoscopic third ventriculostomy in young infants: are there different age distributions? Childs Nerv Syst 22:1537–1541

    Article  PubMed  Google Scholar 

  30. Kulkarni AV, Drake JM, Kestle JR, Mallucci CL, Sgouros S, Constantini S, Canadian Pediatric Neurosurgery Study Group (2010) Predicting who will benefit from endoscopic third ventriculostomy compared with shunt insertion in childhood hydrocephalus using the ETV Success Score. J Neurosurg Pediatr 6:310–315

    Article  PubMed  Google Scholar 

  31. Kulkarni AV, Drake JM, Mallucci CL, Sgouros S, Roth J, Constantini S, Canadian Pediatric Neurosurgery Study Group (2009) Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus. J Pediatr 155:254–259

    Article  PubMed  Google Scholar 

  32. Lipina R, Reguli S, Dolezilová V, Kuncíková M, Podesvová H (2008) Endoscopic third ventriculostomy for obstructive hydrocephalus in children younger than 6 months of age: is it a firstchoice method? Childs Nerv Syst 24:1021–1027

    Article  PubMed  Google Scholar 

  33. Mohanty A, Vasudev MK, Sampath S, Radesh S, Kolluri VRS (2002) Failed endoscopic third ventriculostomy in children: management options. Pediatr Neurosurg 37:304–309 001; 35: 131–135

    Article  PubMed  Google Scholar 

  34. Naftel RP, Reed GT, Kulkarni AV, Wellons JC (2011) Evaluating the Children’s Hospital Alabama endoscopic third ventriculostomy experience using the endoscopic third ventriculostomy success score. J Neurosurg Pediatr 8:494–501

    Article  PubMed  Google Scholar 

  35. O’Brien DF, Seghedoni A, Collins DR, Hayhurst C, Mallucci CL (2006) Is there an indication for ETV in young infants in aetiologies other than isolated aqueduct stenosis? Childs Nerv Syst 22:1565–1572

    Article  PubMed  Google Scholar 

  36. Oertel JMK, Gaab M, Schroeder HW (2009) Endoscopic options in children: experience with 134 procedures. J Neurosurg Pediatr 3:81–89

    Article  PubMed  Google Scholar 

  37. Ogiwara H, Dipatri AJ Jr, Alden TD, Bowman RM, Tomita T (2010) Endoscopic third ventriculostomy for obstructive hydrocephalus in children younger than 6 months of age. Childs Nerv Syst 26:343–347

    Article  PubMed  Google Scholar 

  38. Oi S, Di Rocco C (2006) Proposal of ‘evolution theory in cerebrospinal fluid dynamics’ and minor pathway hydrocephalus in developing immature brain. Childs Nerv Syst 22:662–669

    Article  PubMed  Google Scholar 

  39. Pereira JL, Ayres-Basto R, Seixas M, Vaz MLR (2002) Neuroendoscopia no tratamento da hidrocefalia obstrutiva. Acta Méd Port 15:355–364

    PubMed  Google Scholar 

  40. Peretta P, Ragazzi P, Galarza M, Genitori L, Giordano F, Mussa F, Cinalli G (2006) Complications and pitfalls of neuroendoscopic surgery in children. J Neurosurg Pediatr 105:187–193

    Article  Google Scholar 

  41. Pollay M (2010) The function and structure of the cerebrospinal fluid system. Cerebrospinal Fluid Res 7:9

    Article  PubMed  PubMed Central  Google Scholar 

  42. Rekate HL (2004) Selecting patients for endoscopic third ventriculostomy. Neurosurg Clin N Am 15:39–49

    Article  PubMed  Google Scholar 

  43. Sacko O, Boetto S, Lauwers-Cances V, Dupuy M, Roux FE (2010) Endoscopic third ventriculostomy: outcome analysis in 368 procedures. J Neurosurg Pediatr 5:68–74

    Article  PubMed  Google Scholar 

  44. Siomin V, Cinalli G, Grotenhuis A, Golash A, Oi S, Kothbauer K, Weiner H, Roth J, Beni-Adani L, Pierre-Kahn A, Takahashi Y, Mallucci C, Abbott R, Wisoff J, Constantini S (2002) Endoscopic third ventriculostomy in patients with cerebrospinal fluid infection and/or hemorrhage. J Neurosurg 97(3):519–524

    Article  PubMed  Google Scholar 

  45. Siomin V, Weiner H, Wisoff J, Cinalli G, Pierre-Kahn A, Saint-Rose C, Abbott R, Elran H, Beni-Adani L, Ouaknine G, Constantini S (2001) Repeat endoscopic third ventriculostomy: is it worth trying? Childs Nerv Syst 17:551–555

    Article  PubMed  CAS  Google Scholar 

  46. Teo C, Jones R (1996) Management of hydrocephalus by endoscopic third ventriculostomy in patients with myelomeningocele. Pediatr Neurosurg 25(2):57–63 discussion 6

    Article  PubMed  CAS  Google Scholar 

  47. Wagner W, Koch D (2005) Mechanisms of failure after endoscopic third ventriculostomy in young infants. J Neurosurg 103:43–49

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Duzce University Faculty of Medicine, Konuralp Beldesi, 81100, Duzce, Turkey

    Soner Duru, Canan Subasi & Cengiz Tuncer

  2. Fetal Center, Division of General and Thoracic Surgery, MLC 11020, Cincinnati Children’s Hospital and Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA

    Soner Duru, Jose L Peiro, Marc Oria & Emrah Aydin

  3. Long Island Jewish Medical Center, North Shore University Hospital, The Chiari Institute, Great Neck, Manhasset, NY, USA

    Harold L Rekate

Authors
  1. Soner Duru
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jose L Peiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marc Oria
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Emrah Aydin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Canan Subasi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Cengiz Tuncer
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Harold L Rekate
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Soner Duru.

Ethics declarations

Conflict of interest

The author declares that author has no conflict of interest.

Ethical approval

Duzce University Clinical Researches Ethics Committee has approved this respective study (date: 2017, number 117). This study has been accepted as an e-poster presentation for ESPN biennial congress, 6–9 May 2018, in Bonn, Germany.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Duru, S., Peiro, J.L., Oria, M. et al. Successful endoscopic third ventriculostomy in children depends on age and etiology of hydrocephalus: outcome analysis in 51 pediatric patients. Childs Nerv Syst 34, 1521–1528 (2018). https://doi.org/10.1007/s00381-018-3811-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-018-3811-0

Keywords

Search

Navigation