Evaluating the Children's Hospital of Alabama endoscopic third ventriculostomy experience using the Endoscopic Third Ventriculostomy Success Score: an external validation study

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  • 1 Section of Pediatric Neurosurgery, Division of Neurosurgery, University of Alabama, Children's Hospital, Birmingham, Alabama; and
  • | 2 Division of Neurosurgery, Hospital for Sick Children, Toronto, Canada
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Object

Endoscopic third ventriculostomy (ETV) success is dependent on patient characteristics including age, origin of hydrocephalus, and history of shunt therapy. Using these factors, an Endoscopic Third Ventriculostomy Success Score (ETVSS) model was constructed to predict success of therapy. This study reports a single-institution experience with ETV and explores the ETVSS model validity.

Methods

A retrospective chart review identified 151 consecutive patients who underwent ETV at a pediatric hospital between August 1995 and December 2009. Of these 151, 136 patients had at least 6 months of clinical follow-up. Data concerning patient characteristics, operative characteristics, radiological findings, complications, and success of ETV were collected. The actual success rates were compared with those predicted by the ETVSS model.

Results

The actual success rate of ETV at 6 months was 68.4% (93 of 136 patients), which compared well to the predicted ETVSS of 76.5% ± 12.5% (± SD). The C-statistic was 0.74 (95% CI 0.65–0.83), suggesting that the ability of the ETVSS to discriminate failures from successes was good. Secondary ETV was found to have a hazard ratio for failure of 4.2 (95% CI 2.4–7.2) compared with primary ETV (p < 0.001). The complication rate was 9.3% with no deaths. At the first radiological follow-up, the increased size of ventricles had a hazard ratio for failure of 3.0 (95% CI 1.5–6.0) compared with patients in whom ventricle size either remained stable or decreased (p = 0.002).

Conclusions

The ETVSS closely predicts the actual success of ETV, fitting the statistical model well. Shortcomings of the model were identified in overestimating success in patients with ETVSS ≤ 70, which may be attributable to the poor success of secondary ETVs in the authors' patient population.

Abbreviations used in this paper:

ETV = endoscopic third ventriculostomy; ETVSS = Endoscopic Third Ventriculostomy Success Score; ICP = intracranial pressure; IVH = intraventricular hemorrhage.

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Contributor Notes

Address correspondence to: Robert P. Naftel, M.D., Division of Neurosurgery, University of Alabama at Birmingham, 510 20th Street South, FOT 1062, Birmingham, Alabama 35294-3410. email: naftel@uab.edu.
  • 1

    Abtin K, , Thompson BG, & Walker ML: Basilar artery perforation as a complication of endoscopic third ventriculostomy. Pediatr Neurosurg 28:3541, 1998

    • Search Google Scholar
    • Export Citation
  • 2

    Balthasar AJ, , Kort H, , Cornips EM, , Beuls EA, , Weber JW, & Vles JS: Analysis of the success and failure of endoscopic third ventriculostomy in infants less than 1 year of age. Childs Nerv Syst 23:151155, 2007

    • Search Google Scholar
    • Export Citation
  • 3

    Boschert J, , Hellwig D, & Krauss JK: Endoscopic third ventriculostomy for shunt dysfunction in occlusive hydrocephalus: long-term follow up and review. J Neurosurg 98:10321039, 2003

    • Search Google Scholar
    • Export Citation
  • 4

    Brockmeyer D, , Abtin K, , Carey L, & Walker ML: Endoscopic third ventriculostomy: an outcome analysis. Pediatr Neurosurg 28:236240, 1998

  • 5

    Buxton N, , Macarthur D, , Robertson I, & Punt J: Neuroendoscopic third ventriculostomy for failed shunts. Surg Neurol 60:201204, 2003

  • 6

    Cinalli G, , Salazar C, , Mallucci C, , Yada JZ, , Zerah M, & Sainte-Rose C: The role of endoscopic third ventriculostomy in the management of shunt malfunction. Neurosurgery 43:13231329, 1998

    • Search Google Scholar
    • Export Citation
  • 7

    Cinalli G, , Spennato P, , Ruggiero C, , Aliberti F, , Trischitta V, & Buonocore MC, et al. : Complications following endoscopic intracranial procedures in children. Childs Nerv Syst 23:633644, 2007

    • Search Google Scholar
    • Export Citation
  • 8

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

  • 9

    Drake JM, , Kulkarni AV, & Kestle J: Endoscopic third ventriculostomy versus ventriculoperitoneal shunt in pediatric patients: a decision analysis. Childs Nerv Syst 25:467472, 2009

    • Search Google Scholar
    • Export Citation
  • 10

    Drake JM, & Riva-Cambrin J: Editorial. Can intraoperative assessment of endoscopic third ventriculostomy predict success?. J Neurosurg Pediatr 2:295297, 2008

    • Search Google Scholar
    • Export Citation
  • 11

    Elgamal EA, , El-Dawlatly AA, , Murshid WR, , El-Watidy SM, & Jamjoom ZA: Endoscopic third ventriculostomy for hydrocephalus in children younger than 1 year of age. Childs Nerv Syst 27:111116, 2011

    • Search Google Scholar
    • Export Citation
  • 12

    Erşahin Y, & Arslan D: Complications of endoscopic third ventriculostomy. Childs Nerv Syst 24:943948, 2008

  • 13

    Greenfield JP, , Hoffman C, , Kuo E, , Christos PJ, & Souweidane MM: Intraoperative assessment of endoscopic third ventriculostomy success. Clinical article. J Neurosurg Pediatr 2:298303, 2008

    • Search Google Scholar
    • Export Citation
  • 14

    Griebel R, , Khan M, & Tan L: CSF shunt complications: an analysis of contributory factors. Childs Nerv Syst 1:7780, 1985

  • 15

    Hader WJ, , Walker RL, , Myles ST, & Hamilton M: Complications of endoscopic third ventriculostomy in previously shunted patients. Neurosurgery 63:1 Suppl 1 ONS168ONS175, 2008

    • Search Google Scholar
    • Export Citation
  • 16

    Kombogiorgas D, & Sgouros S: Assessment of the influence of operative factors in the success of endoscopic third ventriculostomy in children. Childs Nerv Syst 22:12561262, 2006

    • Search Google Scholar
    • Export Citation
  • 17

    Kulkarni AV, , Drake JM, , Armstrong DC, & Dirks PB: Imaging correlates of successful endoscopic third ventriculostomy. J Neurosurg 92:915919, 2000

    • Search Google Scholar
    • Export Citation
  • 18

    Kulkarni AV, , Drake JM, , Armstrong DC, & Dirks PB: Measurement of ventricular size: reliability of the frontal and occipital horn ratio compared to subjective assessment. Pediatr Neurosurg 31:6570, 1999

    • Search Google Scholar
    • Export Citation
  • 19

    Kulkarni AV, , Drake JM, , Kestle JR, , Mallucci CL, , Sgouros S, & Constantini S: Endoscopic third ventriculostomy vs cerebrospinal fluid shunt in the treatment of hydrocephalus in children: a propensity score-adjusted analysis. Neurosurgery 67:588593, 2010

    • Search Google Scholar
    • Export Citation
  • 20

    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

    • Search Google Scholar
    • Export Citation
  • 21

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

    • Search Google Scholar
    • Export Citation
  • 22

    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

    • Search Google Scholar
    • Export Citation
  • 23

    Kulkarni AV, , Shams I, , Cochrane DD, & McNeely PD: Quality of life after endoscopic third ventriculostomy and cerebrospinal fluid shunting: an adjusted multivariable analysis in a large cohort. Clinical article. J Neurosurg Pediatr 6:1116, 2010

    • Search Google Scholar
    • Export Citation
  • 24

    Marton E, , Feletti A, , Basaldella L, & Longatti P: Endoscopic third ventriculostomy in previously shunted children: a retrospective study. Childs Nerv Syst 26:937943, 2010

    • Search Google Scholar
    • Export Citation
  • 25

    Naftel RP, , Argo JL, , Shannon CN, , Taylor TH, , Tubbs RS, & Clements RH, et al. : Laparoscopic versus open insertion of the peritoneal catheter in ventriculoperitoneal shunt placement: review of 810 consecutive cases. Clinical article. J Neurosurg 115:151158, 2011

    • Search Google Scholar
    • Export Citation
  • 26

    Naftel RP, , Shannon CN, , Reed GT, , Martin R, , Blount JP, & Tubbs RS, et al. : Small-ventricle neuroendoscopy for pediatric brain tumor management. Clinical article. J Neurosurg Pediatr 7:104110, 2011

    • Search Google Scholar
    • Export Citation
  • 27

    Naftel RP, , Tubbs RS, , Reed GT, & Wellons JC III: Small ventricular access prior to rigid neuroendoscopy. Technical note. J Neurosurg Pediatr 6:325328, 2010

    • Search Google Scholar
    • Export Citation
  • 28

    Navarro R, , Gil-Parra R, , Reitman AJ, , Olavarria G, , Grant JA, & Tomita T: Endoscopic third ventriculostomy in children: early and late complications and their avoidance. Childs Nerv Syst 22:506513, 2006

    • Search Google Scholar
    • Export Citation
  • 29

    O'Brien DF, , Javadpour M, , Collins DR, , Spennato P, & Mallucci CL: Endoscopic third ventriculostomy: an outcome analysis of primary cases and procedures performed after ventriculoperitoneal shunt malfunction. J Neurosurg 103:5 Suppl 393400, 2005

    • Search Google Scholar
    • Export Citation
  • 30

    Ogiwara H, , Dipatri AJ Jr, , Alden TD, , Bowman RM, & Tomita T: Endoscopic third ventriculostomy for obstructive hydrocephalus in children younger than 6 months of age. Childs Nerv Syst 26:343347, 2010

    • Search Google Scholar
    • Export Citation
  • 31

    Peretta P, , Cinalli G, , Spennato P, , Ragazzi P, , Ruggiero C, & Aliberti F, et al. : Long-term results of a second endoscopic third ventriculostomy in children: retrospective analysis of 40 cases. Neurosurgery 65:539547, 2009

    • Search Google Scholar
    • Export Citation
  • 32

    Sacko O, , Boetto S, , Lauwers-Cances V, , Dupuy M, & Roux FE: Endoscopic third ventriculostomy: outcome analysis in 368 procedures. Clinical article. J Neurosurg Pediatr 5:6874, 2010

    • Search Google Scholar
    • Export Citation
  • 33

    Santamarta D, , Martin-Vallejo J, , Díaz-Alvarez A, & Maillo A: Changes in ventricular size after endoscopic third ventriculostomy. Acta Neurochir (Wien) 150:119127, 2008

    • Search Google Scholar
    • Export Citation
  • 34

    Schroeder HW, , Niendorf WR, & Gaab MR: Complications of endoscopic third ventriculostomy. J Neurosurg 96:10321040, 2002

  • 35

    Schroeder HW, , Oertel J, & Gaab MR: Incidence of complications in neuroendoscopic surgery. Childs Nerv Syst 20:878883, 2004

  • 36

    Schroeder HW, , Warzok RW, , Assaf JA, & Gaab MR: Fatal subarachnoid hemorrhage after endoscopic third ventriculostomy. Case report. J Neurosurg 90:153155, 1999

    • Search Google Scholar
    • Export Citation
  • 37

    Schwartz TH, , Ho B, , Prestigiacomo CJ, , Bruce JN, , Feldstein NA, & Goodman RR: Ventricular volume following third ventriculostomy. J Neurosurg 91:2025, 1999

    • Search Google Scholar
    • Export Citation
  • 38

    Schwartz TH, , Yoon SS, , Cutruzzola FW, & Goodman RR: Third ventriculostomy: post-operative ventricular size and outcome. Minim Invasive Neurosurg 39:122129, 1996

    • Search Google Scholar
    • Export Citation
  • 39

    Sekhar LN, , Moossy J, & Guthkelch AN: Malfunctioning ventriculoperitoneal shunts. Clinical and pathological features. J Neurosurg 56:411416, 1982

    • Search Google Scholar
    • Export Citation
  • 40

    Siomin V, , Cinalli G, , Grotenhuis A, , Golash A, , Oi S, & Kothbauer K, et al. : Endoscopic third ventriculostomy in patients with cerebrospinal fluid infection and/or hemorrhage. J Neurosurg 97:519524, 2002

    • Search Google Scholar
    • Export Citation
  • 41

    St George E, , Natarajan K, & Sgouros S: Changes in ventricular volume in hydrocephalic children following successful endoscopic third ventriculostomy. Childs Nerv Syst 20:834838, 2004

    • Search Google Scholar
    • Export Citation
  • 42

    Steyerberg EW, , Harrell FE Jr, , Borsboom GJ, , Eijkemans MJ, , Vergouwe Y, & Habbema JD: Internal validation of predictive models: efficiency of some procedures for logistic regression analysis. J Clin Epidemiol 54:774781, 2001

    • Search Google Scholar
    • Export Citation
  • 43

    Surash S, , Chumas P, , Bhargava D, , Crimmins D, , Straiton J, & Tyagi A: A retrospective analysis of revision endoscopic third ventriculostomy. Childs Nerv Syst 26:16931698, 2010

    • Search Google Scholar
    • Export Citation
  • 44

    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
  • 45

    Warf BC, & Kulkarni AV: Intraoperative assessment of cerebral aqueduct patency and cisternal scarring: impact on success of endoscopic third ventriculostomy in 403 African children. Clinical article. J Neurosurg Pediatr 5:204209, 2010

    • Search Google Scholar
    • Export Citation
  • 46

    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

    • Search Google Scholar
    • Export Citation
  • 47

    Wellons JC III, , Tubbs RS, , Banks JT, , Grabb B, , Blount JP, & Oakes WJ, et al. : Long-term control of hydrocephalus via endoscopic third ventriculostomy in children with tectal plate gliomas. Neurosurgery 51:6368, 2002

    • Search Google Scholar
    • Export Citation

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