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. 2020 Nov;36(11):2725-2731.
doi: 10.1007/s00381-020-04585-8. Epub 2020 Mar 28.

ETV in infancy and childhood below 2 years of age for treatment of hydrocephalus

Ahmed El Damaty  1 , Sascha Marx  2 , Gesa Cohrs  3 , Marcus Vollmer  4 , Ahmed Eltanahy  5   6 , Ehab El Refaee  2   7 , Joerg Baldauf  2 , Steffen Fleck  2 , Heidi Baechli  8 , Ahmed Zohdi  7 , Michael Synowitz  3 , Andreas Unterberg  8 , Henry W S Schroeder  2
Affiliations

ETV in infancy and childhood below 2 years of age for treatment of hydrocephalus

Ahmed El Damaty et al. Childs Nerv Syst. 2020 Nov.

Abstract

Purpose: Age and etiology play a crucial role in success of endoscopic third ventriculostomy (ETV) as a treatment of obstructive hydrocephalus. Outcome is worse in infants, and controversies still exist whether ETV is superior to shunt placement. We retrospectively analyzed 70 patients below 2 years from 4 different centers treated with ETV and assessed success.

Methods: Children < 2 years who received an ETV within 1994-2018 were included. Patients were classified according to age and etiology; < 3, 4-12, and 13-24 months, etiologically; aqueductal stenosis, post-hemorrhagic-hydrocephalus (PHH), tumor-related, fourth ventricle outflow obstruction, with Chiari-type II and following CSF infection. We investigated statistically the predictors for ETV success through computing Kaplan-Meier estimates using patient's follow-up time and time to ETV failure.

Results: We collected 70 patients. ETV success rate was 41.4%. The highest rate was in tumor-related hydrocephalus and fourth ventricle outlet obstruction (62.5%, 60%) and the lowest rate was in Chiari-type II and following infection (16.7%, 0%). The below 3 months age group showed relatively lower success rate (33.3%) in comparison to older groups which showed similar results (46.4%, 46.6%). Statistically, a previous VP shunt was a predictor for failure (p value < 0.05).

Conclusion: Factors suggesting a high possibility of failure were age < 3 months and etiology such as Chiari-type II or following infection. Altered CSF dynamics in patients with PHH and under-developed arachnoid villi may play a role in ETV failure. We do not recommend ETV as first line in children < 3 months of age or in case of Chiari II or following infection.

Keywords: Aqueduct stenosis; Endoscopic third ventriculostomy; Obstructive hydrocephalus; Post-hemorrhagic.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
Stacked column chart showing outcome of ETV according to etiology
Fig. 2
Fig. 2
ETV failure over the follow-up time indicated as Kaplan-Meier estimators using the different age groups. Log-rank tests were conducted to check the hypothesis of the equality of event time distributions
Fig. 3
Fig. 3
ETV failure over the follow-up time indicated as Kaplan-Meier estimators using the differentiation between patients with a previous shunt or not are shown. Log-rank tests were conducted to check the hypothesis of the equality of event time distributions
See this image and copyright information in PMC

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