Endoscopic third ventriculostomy revision after failure of initial endoscopic third ventriculostomy and choroid plexus cauterization

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  • 1 Department of Neurosurgery, Children’s of Alabama, The University of Alabama at Birmingham, Birmingham, Alabama;
  • | 2 Departments of Pediatrics and
  • | 3 Neurosurgery, University of Utah, Salt Lake City, Utah;
  • | 4 Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada;
  • | 5 Department of Neurosurgery, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh, Pennsylvania;
  • | 6 Department of Neurosurgery, Vanderbilt University Medical Center, and Surgical Outcomes Center for Kids, Monroe Carell Jr. Children’s Hospital at Vanderbilt University, Nashville, Tennessee;
  • | 7 Department of Neurosurgery, The Johns Hopkins Hospital, Johns Hopkins University, Baltimore, Maryland;
  • | 8 Department of Neurosurgery, Texas Children’s Hospital, Houston, Texas;
  • | 9 Department of Neurosurgery, The Ohio State University College of Medicine, Columbus, Ohio;
  • | 10 Department of Neurosurgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri;
  • | 11 Division of Neurosurgery, British Columbia Children’s Hospital, The University of British Columbia, Vancouver, British Columbia, Canada;
  • | 12 Department of Neurosurgery, Children’s Hospital Colorado, Colorado Springs, Colorado;
  • | 13 Department of Neurosurgery, Seattle Children’s Hospital, University of Washington, Seattle, Washington;
  • | 14 Department of Neurosurgery, Children’s Hospital Los Angeles, University of Southern California, Los Angeles, California;
  • | 15 Department of Pediatrics, Children’s Hospital Los Angeles, University of Southern California, Los Angeles, California; and
  • | 16 Division of Neurosurgery, Alberta Children’s Hospital, University of Calgary, Alberta, Canada
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OBJECTIVE

Primary treatment of hydrocephalus with endoscopic third ventriculostomy (ETV) and choroid plexus cauterization (CPC) is well described in the neurosurgical literature, with wide reported ranges of success and complication rates. The purpose of this study was to describe the safety and efficacy of ETV revision after initial ETV+CPC failure.

METHODS

Prospectively collected data in the Hydrocephalus Clinical Research Network Core Data Project registry were reviewed. Children who underwent ETV+CPC as the initial treatment for hydrocephalus between 2013 and 2019 and in whom the initial ETV+CPC was completed (i.e., not abandoned) were included. Log-rank survival analysis (the primary analysis) was used to compare time to failure (defined as any other surgical treatment for hydrocephalus or death related to hydrocephalus) of initial ETV+CPC versus that of ETV revision by using random-effects modeling to account for the inclusion of patients in both the initial and revision groups. Secondary analysis compared ETV revision to shunt placement after failure of initial ETV+CPC by using the log-rank test, as well as shunt failure after ETV+CPC to that after ETV revision. Cox regression analysis was used to identify predictors of failure among children treated with ETV revision.

RESULTS

The authors identified 521 ETV+CPC procedures that met their inclusion criteria. Ninety-one children underwent ETV revision after ETV+CPC failure. ETV revision had a lower 1-year success rate than initial ETV+CPC (29.5% vs 45%, p < 0.001). ETV revision after initial ETV+CPC failure had a lower success rate than shunting (29.5% vs 77.8%, p < 0.001). Shunt survival after initial ETV+CPC failure was not significantly different from shunt survival after ETV revision failure (p = 0.963). Complication rates were similar for all examined surgical procedures (initial ETV+CPC, ETV revision, ventriculoperitoneal shunt [VPS] placement after ETV+CPC, and VPS placement after ETV revision). Only young age was predictive of ETV revision failure (p = 0.02).

CONCLUSIONS

ETV revision had a significantly lower 1-year success rate than initial ETV+CPC and VPS placement after ETV+CPC. Complication rates were similar for all studied procedures. Younger age, but not time since initial ETV+CPC, was a risk factor for ETV revision failure.

ABBREVIATIONS

CPC = choroid plexus cauterization; ETV = endoscopic third ventriculostomy; ETVSS = ETV Success Score; FOHR = frontal-occipital horn ratio; HCRN = Hydrocephalus Clinical Research Network; HR = hazard ratio; IQR = interquartile range; IVH = intraventricular hemorrhage; VPS = ventriculoperitoneal shunt.
Illustration from Cinalli et al. (pp 119–127). Printed with permission from © CC Medical Arts.

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

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