Preoperative judgement of which children is likely to benefit from endoscopic third ventriculostomy (ETV) is still the most difficult challenge. This study aimed to compare the efficiency of third ventricular floor bowing (TVFB) and ETV success score (ETVSS) in selecting ETV candidates and achieve a better preoperative patient selection method for ETV based on our institutional experience. Children (≤ 16 years old) with newly diagnosed hydrocephalus treated with ETV between January 2013 and June 2018 were included in this prospective study. Patients with TVFB will receive ETV procedure in the pediatric subgroup of our department. ETVSS was calculated in every patient. The ETVSS predicted ETV success rate and the actual ETV success rate in our institution were compared and further analyzed. One hundred twenty-nine children with TVFB were enrolled in our study. The mean age at ETV was 5.84 ± 5.17 years (range, 0.04–16). Brain tumors, aqueductal stenosis, and inflammatory are the most common hydrocephalus etiologies. The most common complication was noninfectious fever (3.1%). During the average follow-up of 19.5 ± 14.95 months, twenty-five patients had depicted ETV failure. The actual ETV success rate (81%) in our study was higher than the success rate (69%) predicted by ETVSS. TVFB is a pragmatic, efficient, and simple model to predict the ETV outcome. We suggest that for hydrocephalic patients with preoperative third ventricular floor bowing, ETV should be the first-treatment choice regardless of the ETV success score. And for patients without such sign, ETVSS should be applied to select ETV candidates.
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Dlouhy BJ, Capuano AW, Madhavan K, Torner JC, Greenlee JD (2012) Preoperative third ventricular bowing as a predictor of endoscopic third ventriculostomy success. J Neurosurg Pediatr 9:182–190. https://doi.org/10.3171/2011.11.peds11495
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. https://doi.org/10.3171/2011.8.PEDS1166
Foroughi M, Wong A, Steinbok P, Singhal A, Sargent MA, Cochrane DD (2011) Third ventricular shape: a predictor of endoscopic third ventriculostomy success in pediatric patients. J Neurosurg Pediatr 7:389–396. https://doi.org/10.3171/2011.1.peds10461
Garcia LG, Lopez BR, Botella GI, Paez MD, da Rosa SP, Rius F, Sanchez MA (2012) Endoscopic third Ventriculostomy success score (ETVSS) predicting success in a series of 50 pediatric patients. Are the outcomes of our patients predictable? Child's nervous system. ChNS : official journal of the International Society for Pediatric Neurosurgery 28:1157–1162. https://doi.org/10.1007/s00381-012-1836-3
Gianaris TJ, Nazar R, Middlebrook E, Gonda DD, Jea A, Fulkerson DH (2017) Failure of ETV in patients with the highest ETV success scores. J Neurosurg Pediatr 20:225–231. https://doi.org/10.3171/2016.7.peds1655
Hailong F, Guangfu H, Haibin T, Hong P, Yong C, Weidong L, Dongdong Z (2008) Endoscopic third ventriculostomy in the management of communicating hydrocephalus: a preliminary study. J Neurosurg 109:923–930. https://doi.org/10.3171/JNS/2008/109/11/0923
Kahle KT, Kulkarni AV, Limbrick DD, Warf BC (2016) Hydrocephalus in children. Lancet 387:788–799. https://doi.org/10.1016/s0140-6736(15)60694-8
Kehler U, Gliemroth J (2003) Extraventricular intracisternal obstructive hydrocephalus--a hypothesis to explain successful 3rd ventriculostomy in communicating hydrocephalus. Pediatr Neurosurg 38:98–101. https://doi.org/10.1159/000068053
Kehler U, Regelsberger J, Gliemroth J, Westphal M (2006) Outcome prediction of third ventriculostomy: a proposed hydrocephalus grading system. Minim Invasive Neurosurg 49:238–243. https://doi.org/10.1055/s-2006-950382
Kulkarni AV, Drake JM, Kestle JR, Mallucci CL, Sgouros S, Constantini S, Canadian Pediatric Neurosurgery Study G (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. https://doi.org/10.3171/2010.8.PEDS103
Kulkarni AV, Drake JM, Mallucci CL, Sgouros S, Roth J, Constantini S (2009) Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus. J Pediatr 155:254–259.e251. https://doi.org/10.1016/j.jpeds.2009.02.048
Kulkarni AV, Riva-Cambrin J, Browd SR (2011) Use of the ETV success score to explain the variation in reported endoscopic third ventriculostomy success rates among published case series of childhood hydrocephalus. J Neurosurg Pediatr 7:143–146. https://doi.org/10.3171/2010.11.peds10296
Kulkarni AV, Riva-Cambrin J, Holubkov R, Browd SR, Cochrane DD, Drake JM, Limbrick DD, Rozzelle CJ, Simon TD, Tamber MS, Wellons JC 3rd, Whitehead WE, Kestle JR (2016) Endoscopic third ventriculostomy in children: prospective, multicenter results from the hydrocephalus clinical research network. J Neurosurg Pediatr 18:423–429. https://doi.org/10.3171/2016.4.peds163
Labidi M, Lavoie P, Lapointe G, Obaid S, Weil AG, Bojanowski MW, Turmel A (2015) Predicting success of endoscopic third ventriculostomy: validation of the ETV success score in a mixed population of adult and pediatric patients. J Neurosurg 123:1447–1455. https://doi.org/10.3171/2014.12.jns141240
Naftel RP, Reed GT, Kulkarni AV, Wellons JC (2011) Evaluating the Children's Hospital of Alabama endoscopic third ventriculostomy experience using the endoscopic third Ventriculostomy success score: an external validation study. J Neurosurg Pediatr 8:494–501. https://doi.org/10.3171/2011.8.peds1145
Raouf A, Zidan I, Mohamed E (2015) Endoscopic third ventriculostomy for post-inflammatory hydrocephalus in pediatric patients: is it worth a try? Neurosurg Rev 38:149–155; discussion 155. https://doi.org/10.1007/s10143-014-0582-2
Singh I, Haris M, Husain M, Husain N, Rastogi M, Gupta RK (2008) Role of endoscopic third ventriculostomy in patients with communicating hydrocephalus: an evaluation by MR ventriculography. Neurosurg Rev 31:319–325. https://doi.org/10.1007/s10143-008-0137-5
Sufianov AA, Sufianova GZ, Iakimov IA (2010) Endoscopic third ventriculostomy in patients younger than 2 years: outcome analysis of 41 hydrocephalus cases. J Neurosurg Pediatr 5:392–401. https://doi.org/10.3171/2009.11.PEDS09197
Wang Q, Hui X, Li Q, Ju Y (2018) Letter to the editor. Preoperative third ventricle shape and ETV. J Neurosurg Pediatr 21:542–543. https://doi.org/10.3171/2017.10.PEDS17534
Warf BC, Mugamba J, Kulkarni AV (2010) Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus in Uganda: report of a scoring system that predicts success. J Neurosurg Pediatr 5:143–148. https://doi.org/10.3171/2009.9.peds09196
This work was financially supported by Sichuan Science and Technology Support Program (No. 2018SZ0043).
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Wang, Q., Cheng, J., Zhang, S. et al. Prediction of endoscopic third ventriculostomy (ETV) success with preoperative third ventricle floor bowing (TVFB): a supplement to ETV success score. Neurosurg Rev 43, 1575–1581 (2020). https://doi.org/10.1007/s10143-019-01178-1
- Endoscopic third ventriculostomy
- Third ventricle floor
- ETV success score