Pediatric endoscopic third ventriculostomy: a population-based study

Clinical article

Sandi LamDepartment of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas;

Search for other papers by Sandi Lam in
jns
Google Scholar
PubMed
Close
 M.D., M.B.A.
,
Dominic HarrisDepartment of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas;

Search for other papers by Dominic Harris in
jns
Google Scholar
PubMed
Close
 B.A.
,
Brandon G. RocqueSection of Pediatric Neurosurgery, University of Alabama at Birmingham, Alabama; and

Search for other papers by Brandon G. Rocque in
jns
Google Scholar
PubMed
Close
 M.D., M.S.
, and
Sandra A. HamCenter for Health and Social Sciences, University of Chicago, Illinois

Search for other papers by Sandra A. Ham in
jns
Google Scholar
PubMed
Close
 M.A., M.S.
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $525.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $624.00
USD  $45.00
USD  $525.00
USD  $624.00
Print or Print + Online Sign in

Object

Endoscopic third ventriculostomy (ETV) is an alternative to ventriculoperitoneal shunting for hydrocephalus treatment. Choice of treatment options raises questions about which patients are likely to benefit from ETV. The authors performed a population-based analysis using an administrative claims database, examining current practice and outcomes for pediatric patients in the US.

Methods

The authors queried the MarketScan (Truven Health Analytics) database for Current Procedural Terminology codes corresponding to ETV and ventriculoperitoneal shunting from 2003 to 2011; they included patients 19 years or younger and extracted data from initial and subsequent hospitalizations. Hydrocephalus etiology was classified with ICD-9-CM coding. ETV failure was defined as any subsequent ETV or shunt procedure.

Results

Five hundred one patients underwent ETV. Of these, 46% were female. The mean age was 8.7 ± 6.4 years (± SD). The mean follow-up was 1.9 ± 1.8 years. Etiology of hydrocephalus was primarily tumor (41.7%) and congenital/aqueductal stenosis (24.4%). ETV was successful in 354 patients (71%). The mean time to failure was 109.9 ± 233 days. Of the 147 patients with ETV failure, 35 (24%) underwent repeat ETV and 112 (76%) had shunt placement. Patients in age groups 0 to < 6 months and 6 months to < 1 year had a significantly higher rate of ETV failure than those 10–19 years (HR 2.9, p = 0.05; and HR 2.3, p = 0.001, respectively). History of prior shunt was associated with higher risk of failure (HR 2.5, p < 0.001). There were no significant associations between hydrocephalus etiology and risk of failure. A second wave of failures occurred at 2.5–3.5 years postoperative in tumor and congenital/aqueductal stenosis patients; this was not observed in other etiology groups.

Conclusions

This study represents a cross-section of nationwide ETV practice over 9 years. ETV success was more likely among children 1 year and older and those with no history of prior shunt.

Abbreviations used in this paper:

CPT = Current Procedural Terminology; ETV = endoscopic third ventriculostomy; IVH = intraventricular hemorrhage; LOS = length of stay; MMC = myelomeningocele; VP = ventriculoperitoneal.
  • Collapse
  • Expand
  • 1

    Baldauf J, , Oertel J, , Gaab MR, & Schroeder HW: Endoscopic third ventriculostomy in children younger than 2 years of age. Childs Nerv Syst 23:623626, 2007

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2

    Drake J, , Chumas P, , Kestle J, , Pierre-Kahn A, , Vinchon M, & Brown J, et al.: Late rapid deterioration after endoscopic third ventriculostomy: additional cases and review of the literature. J Neurosurg 105 :2 Suppl 118126, 2006

    • Search Google Scholar
    • Export Citation
  • 3

    Drake JM: Canadian Pediatric Neurosurgery Study Group: Endoscopic third ventriculostomy in pediatric patients: the Canadian experience. Neurosurgery 60:881886, 2007

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4

    Durnford AJ, , Kirkham FJ, , Mathad N, & Sparrow OC: Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus: validation of a success score that predicts long-term outcome. Clinical article. J Neurosurg Pediatr 8:489493, 2011

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5

    Fernell E, , Hagberg G, & Hagberg B: Infantile hydrocephalus epidemiology: an indicator of enhanced survival. Arch Dis Child Fetal Neonatal Ed 70:F123F128, 1994

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6

    Garne E, , Loane M, , Addor MC, , Boyd PA, , Barisic I, & Dolk H: Congenital hydrocephalus—prevalence, prenatal diagnosis and outcome of pregnancy in four European regions. Eur J Paediatr Neurol 14:150155, 2010

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7

    Jeng S, , Gupta N, , Wrensch M, , Zhao S, & Wu YW: Prevalence of congenital hydrocephalus in California, 1991-2000. Pediatr Neurol 45:6771, 2011

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8

    Kadrian D, , van Gelder J, , Florida D, , Jones R, , Vonau M, & Teo C, et al.: Long-term reliability of endoscopic third ventriculostomy. Neurosurgery 62 :Suppl 2 614621, 2008

    • Search Google Scholar
    • Export Citation
  • 9

    Koch-Wiewrodt D, & Wagner W: Success and failure of endoscopic third ventriculostomy in young infants: are there different age distributions?. Childs Nerv Syst 22:15371541, 2006

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10

    Kulkarni AV, , Drake JM, , Kestle JR, , Mallucci CL, , Sgouros S, & Constantini S: Predicting who will benefit from endoscopic third ventriculostomy compared with shunt insertion in childhood hydrocephalus using the ETV Success Score. Clinical article. J Neurosurg Pediatr 6:310315, 2010. (Erratum in J Neurosurg Pediatr 7: 221, 2011)

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11

    Kulkarni AV, , Drake JM, , Mallucci CL, , Sgouros S, , Roth J, & Constantini S, et al.: Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus. J Pediatr 155:254259.e1, 2009

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12

    Kulkarni AV, , Riva-Cambrin J, & Browd SR: Use of the ETV Success Score to explain the variation in reported endoscopic third ventriculostomy success rates among published case series of childhood hydrocephalus. Clinical article. J Neurosurg Pediatr 7:143146, 2011

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13

    Lad SP, , Babu R, , Rhee MS, , Franklin RL, , Ugiliweneza B, & Hodes J, et al.: Long-term economic impact of coiling vs clipping for unruptured intracranial aneurysms. Neurosurgery 72:10001013, 2013

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14

    Naftel RP, , Reed GT, , Kulkarni AV, & Wellons JC: Evaluating the Children's Hospital of Alabama endoscopic third ventriculostomy experience using the Endoscopic Third Ventriculostomy Success Score: an external validation study. Clinical article. J Neurosurg Pediatr 8:494501, 2011

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15

    O'Brien DF, , Hayhurst C, , Pizer B, & Mallucci CL: Outcomes in patients undergoing single-trajectory endoscopic third ventriculostomy and endoscopic biopsy for midline tumors presenting with obstructive hydrocephalus. J Neurosurg 105 :3 Suppl 219226, 2006

    • Search Google Scholar
    • Export Citation
  • 16

    Persson EK, , Anderson S, , Wiklund LM, & Uvebrant P: Hydrocephalus in children born in 1999-2002: epidemiology, outcome and ophthalmological findings. Childs Nerv Syst 23:11111118, 2007

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17

    Simon TD, , Hall M, , Riva-Cambrin J, , Albert JE, , Jeffries HE, & Lafleur B, et al.: Infection rates following initial cerebrospinal fluid shunt placement across pediatric hospitals in the United States. Clinical article. J Neurosurg Pediatr 4:156165, 2009

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18

    Simon TD, , Riva-Cambrin J, , Srivastava R, , Bratton SL, , Dean JM, & Kestle JR: Hospital care for children with hydrocephalus in the United States: utilization, charges, comorbidities, and deaths. J Neurosurg Pediatr 1:131137, 2008

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19

    Sufianov AA, , Sufianova GZ, & Iakimov IA: Endoscopic third ventriculostomy in patients younger than 2 years: outcome analysis of 41 hydrocephalus cases. Clinical article. J Neurosurg Pediatr 5:392401, 2010

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20

    Vogel TW, , Bahuleyan B, , Robinson S, & Cohen AR: The role of endoscopic third ventriculostomy in the treatment of hydrocephalus. Clinical article. J Neurosurg Pediatr 12:5461, 2013

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21

    Wagner W, & Koch D: Mechanisms of failure after endoscopic third ventriculostomy in young infants. J Neurosurg 103 :1 Suppl 4349, 2005

  • 22

    Warf BC: Comparison of endoscopic third ventriculostomy alone and combined with choroid plexus cauterization in infants younger than 1 year of age: a prospective study in 550 African children. J Neurosurg 103 :6 Suppl 475481, 2005

    • Search Google Scholar
    • Export Citation
  • 23

    Warf BC: Hydrocephalus in Uganda: the predominance of infectious origin and primary management with endoscopic third ventriculostomy. J Neurosurg 102 :1 Suppl 115, 2005

    • Search Google Scholar
    • Export Citation
  • 24

    Warf BC: The impact of combined endoscopic third ventriculostomy and choroid plexus cauterization on the management of pediatric hydrocephalus in developing countries. World Neurosurg 79:2 Suppl S23.e13S23.e15, 2013

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25

    Warf BC, , Mugamba J, & Kulkarni AV: Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus in Uganda: report of a scoring system that predicts success. Clinical article. J Neurosurg Pediatr 5:143148, 2010

    • Crossref
    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 949 226 37
Full Text Views 663 39 0
PDF Downloads 320 40 0
EPUB Downloads 0 0 0