Endoscopic management of pediatric complex hydrocephalus-a procedure survival analysis and clinico-radiological outcome study using ventricular volumetry

Abstract

Objectives: To evaluate the survival of endoscopic procedures performed for complex hydrocephalus, quantify clinical outcomes in standardized scales, and assess correlation with radiological outcomes using ventricular volumetry.

Methods: A retrospective analysis of patients with complex hydrocephalus, managed with neuroendoscopic procedures at a tertiary neurosurgical center over 20 years, was performed. In addition to demographic and clinical details, pre-operative and follow-up clinical status (using the Pediatric Functional Status Score (FSS) and Pediatric Cerebral Performance Category (PCPC) Scales) was assessed. Procedure failure was defined as any subsequent surgical procedure for the management of hydrocephalus and survival as time from the first endoscopic procedure to failure or last available follow-up. Ventricular volume and ventricle:brain volume ratio was calculated using serial imaging.

Results: We analyzed 40 pediatric patients who met the study criteria with a mean age of 19 months, the most common subtype being post-meningitic multiloculated hydrocephalus (70%). The median survival of an endoscopic procedure was 24 months (5.7-33.6 months). Over a median follow-up duration of 15 months, 28 days (2.2-111 months), median FSS improved by 5 points, and median PCPC score improved from 4 (severe disability) to 3 (moderate disability). Over a median radiological follow-up of 5.9 months, the median percentage decrease in ventricle size was 27.14%, and the ventricle:brain volume ratio was 30.57%. A strong positive correlation (r = 0.58-0.75) was noted between the decrease in ventricular volume and ventricle:brain ratio with improvement in FSS and PCPC scores.

Conclusions: Endoscopic procedures, although effective in managing complex hydrocephalus, may not be a one-stop long-term solution, which we have described in terms of procedure survival. Objective scales and ventricular volumetry to quantify clinical and radiological improvement demonstrated a significant correlation, even in complex hydrocephalus. The potential of ventricular volumetry as a prognostic factor in complex hydrocephalus is postulated.

Keywords: Endoscopy; Multiloculated; Post-meningitic; Volumetry.