Endoscopic third ventriculostomy in previously shunt-treated patients

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  • 1 Department of Neurosurgery, Children’s of Alabama, The University of Alabama at 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, Nashville, Tennessee;
  • | 7 Surgical Outcomes Center for Kids, Monroe Carell Jr. Children’s Hospital at Vanderbilt University, Nashville, Tennessee;
  • | 8 Department of Neurosurgery, The Johns Hopkins Hospital, Johns Hopkins University, Baltimore, Maryland;
  • | 9 Department of Neurosurgery, Texas Children’s Hospital, Houston, Texas;
  • | 10 Department of Neurosurgery, The Ohio State University College of Medicine, Columbus, Ohio;
  • | 11 Department of Neurosurgery, Washington University School of Medicine in St. Louis, Missouri;
  • | 12 Division of Neurosurgery, British Columbia Children’s Hospital, The University of British Columbia, Vancouver, British Columbia, Canada;
  • | 13 Department of Neurosurgery, Children’s Hospital Colorado, Colorado Springs, Colorado;
  • | 14 Department of Neurosurgery, Seattle Children’s Hospital, University of Washington, Seattle, Washington;
  • | 15 Departments of Neurosurgery and
  • | 16 Pediatrics, Children’s Hospital Los Angeles, University of Southern California, Los Angeles, California; and
  • | 17 Division of Neurosurgery, Alberta Children’s Hospital, University of Calgary, Alberta, Canada
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OBJECTIVE

Endoscopic third ventriculostomy (ETV) is an option for treatment of hydrocephalus, including for patients who have a history of previous treatment with CSF shunt insertion. The purpose of this study was to report the success of postshunt ETV by using data from a multicenter prospective registry.

METHODS

Prospectively collected data in the Hydrocephalus Clinical Research Network (HCRN) Core Data Project (i.e., HCRN Registry) were reviewed. Children who underwent ETV between 2008 and 2019 and had a history of previous treatment with a CSF shunt were included. A Kaplan-Meier survival curve was created for the primary outcome: time from postshunt ETV to subsequent CSF shunt placement or revision. Univariable Cox proportional hazards models were created to evaluate for an association between clinical and demographic variables and subsequent shunt surgery. Postshunt ETV complications were also identified and categorized.

RESULTS

A total of 203 children were included: 57% male and 43% female; 74% White, 23% Black, and 4% other race. The most common hydrocephalus etiologies were postintraventricular hemorrhage secondary to prematurity (56, 28%) and aqueductal stenosis (42, 21%). The ETV Success Score ranged from 10 to 80. The median patient age was 4.1 years. The overall success of postshunt ETV at 6 months was 41%. Only the surgeon’s report of a clear view of the basilar artery was associated with a lower likelihood of postshunt ETV failure (HR 0.43, 95% CI 0.23–0.82, p = 0.009). None of the following variables were associated with postshunt ETV success: age at the time of postshunt ETV, etiology of hydrocephalus, sex, race, ventricle size, number of previous shunt operations, ETV performed at time of shunt infection, and use of external ventricular drainage. Overall, complications were reported in 22% of patients, with CSF leak (8.6%) being the most common complication.

CONCLUSIONS

Postshunt ETV was successful in treating hydrocephalus, without subsequent need for a CSF shunt, in 41% of patients, with a clear view of the basilar artery being the only variable significantly associated with success. Complications occurred in 22% of patients. ETV is an option for treatment of hydrocephalus in children who have previously undergone shunt placement, but with a lower than expected likelihood of success.

ABBREVIATIONS

BA = basilar artery; CPC = choroid plexus cauterization; ETV = endoscopic third ventriculostomy; ETVSS = ETV Success Score; EVD = external ventricular drain; FOR = frontal/occipital horn ratio; HCRN = Hydrocephalus Clinical Research Network; IQR = interquartile range; IVH = intraventricular hemorrhage.

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

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  • 1

    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. J Neurosurg Pediatr. 2010;6(4):310315.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2

    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. J Neurosurg Pediatr. 2011;7(2):143146.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3

    Furtado LMF, da Costa Val Filho JA, Holliday JB, et al. Endoscopic third ventriculostomy in patients with myelomeningocele after shunt failure. Childs Nerv Syst. 2020;36(12):30473052.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4

    Heshmati B, Habibi Z, Golpayegani M, Salari F, Anbarlouei M, Nejat F. Endoscopic third ventriculostomy in children with failed ventriculoperitoneal shunt. Asian J Neurosurg. 2019;14(2):399402.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5

    Irrinki RNNS, Bawa M, Hegde S, Chhabra R, Gupta V, Gupta SK. Functional and radiological parameters to assess outcome of endoscopic third ventriculostomy in shunt failure patients. J Pediatr Neurosci. 2019;14(2):6569.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6

    Shaikh S, Deopujari CE, Karmarkar V, Muley K, Mohanty C. Role of secondary endoscopic third ventriculostomy in children: review of an institutional experience. Pediatr Neurosurg. 2019;54(3):188195.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7

    Lee SH, Kong DS, Seol HJ, Shin HJ. Endoscopic third ventriculostomy in patients with shunt malfunction. J Korean Neurosurg Soc. 2011;49(4):217221.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8

    Bilginer B, Oguz KK, Akalan N. Endoscopic third ventriculostomy for malfunction in previously shunted infants. Childs Nerv Syst. 2009;25(6):683688.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9

    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. 2005;103(5)(suppl):393400.

    • Search Google Scholar
    • Export Citation
  • 10

    Brichtova E, Chlachula M, Hrbac T, Lipina R. Endoscopic third ventriculostomy in previously shunted children. Minim Invasive Surg. 2013;2013:584567.

    • Search Google Scholar
    • Export Citation
  • 11

    Marton E, Feletti A, Basaldella L, Longatti P. Endoscopic third ventriculostomy in previously shunted children: a retrospective study. Childs Nerv Syst. 2010;26(7):937943.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12

    Takeshige N, Uchikado H, Nakashima D, et al. Endoscopic third ventriculostomy for myelomeningocele-related hydrocephalus after shunt failure: long-term outcome in a series of 8 patients. Clin Neurol Neurosurg. 2021;201:106406.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13

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

    • Search Google Scholar
    • Export Citation
  • 14

    Iglesias S, Ros B, Ibáñez G, Delgado A, Ros Á, Arráez . Shunt independence in paediatric hydrocephalus: our 16-year experience and review. Childs Nerv Syst. 2019;35(9):15471555.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15

    Choudhary A, Sobti S, Zambre S, Bhaskar S. Endoscopic third ventriculostomy in failed ventriculoperitoneal shunt in pediatric population. Asian J Neurosurg. 2020;15(4):937940.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16

    Talamonti G, Nichelatti M, Picano M, Marcati E, D’Aliberti G, Cenzato M. Endoscopic third ventriculostomy in cases of ventriculoperitoneal shunt malfunction: does shunt duration play a role? World Neurosurg. 2019;127:e799e808.

    • Search Google Scholar
    • Export Citation
  • 17

    Zhao R, Shi W, Yang H, Li H. Endoscopic third ventriculostomy instead of shunt revision in children younger than 3 years of age. World Neurosurg. 2016;88:9296.

    • Search Google Scholar
    • Export Citation
  • 18

    Chhun V, Sacko O, Boetto S, Roux FE. Third ventriculocisternostomy for shunt failure. World Neurosurg. 2015;83(6):970975.

  • 19

    Waqar M, Ellenbogen JR, Mallucci C. Endoscopic third ventriculostomy for shunt malfunction in children: a review. J Clin Neurosci. 2018;51:611.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20

    Boschert J, Hellwig D, Krauss JK. Endoscopic third ventriculostomy for shunt dysfunction in occlusive hydrocephalus: long-term follow up and review. J Neurosurg. 2003;98(5):10321039.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21

    Tamber MS, Kestle JRW, Reeder RW, et al. Temporal trends in surgical procedures for pediatric hydrocephalus: an analysis of the Hydrocephalus Clinical Research Network Core Data Project. J Neurosurg Pediatr. 2020;27(3):269276.

    • Search Google Scholar
    • Export Citation
  • 22

    Kulkarni AV, Riva-Cambrin J, Holubkov R, et al. Endoscopic third ventriculostomy in children: prospective, multicenter results from the Hydrocephalus Clinical Research Network. J Neurosurg Pediatr. 2016;18(4):423429.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23

    Riva-Cambrin J, Kestle JRW, Rozzelle CJ, et al. Predictors of success for combined endoscopic third ventriculostomy and choroid plexus cauterization in a North American setting: a Hydrocephalus Clinical Research Network study. J Neurosurg Pediatr. 2019;24(2):128138.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24

    Greenfield JP, Hoffman C, Kuo E, Christos PJ, Souweidane MM. Intraoperative assessment of endoscopic third ventriculostomy success. J Neurosurg Pediatr. 2008;2(5):298303.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25

    He L, Gannon S, Shannon CN, Rocque BG, Riva-Cambrin J, Naftel RP. Surgeon interrater reliability in the endoscopic assessment of cistern scarring and aqueduct patency. J Neurosurg Pediatr. 2016;18(3):320324.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 26

    Buxton N, Macarthur D, Robertson I, Punt J. Neuroendoscopic third ventriculostomy for failed shunts. Surg Neurol. 2003;60(3):201204.

  • 27

    Bouras T, Sgouros S. Complications of endoscopic third ventriculostomy. J Neurosurg Pediatr. 2011;7(6):643649.

  • 28

    Naftel RP, Shannon CN, Reed GT, et al. Small-ventricle neuroendoscopy for pediatric brain tumor management. J Neurosurg Pediatr. 2011;7(1):104110.

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