OBJECTIVE: Reports from relatively small series of pediatric patients predominantly from single centers have hampered accurate analysis of outcome from endoscopic third ventriculostomy. We combined patients from nine pediatric neurosurgery centers across Canada to obtain a better estimate of outcome and identify factors affecting success of the procedure. METHODS: Databases were recoded for uniformity. Failure of the procedure was defined as any subsequent operation or death resulting from hydrocephalus. Time to failure was analyzed by Kaplan-Meier estimate and Cox proportional hazard analysis. RESULTS: During a 15-year period (1989-2004), 368 patients underwent the procedure. The average age was 6.5 years, and 57% were male. Aqueduct stenosis and tumors were the most common etiology, comprising 34 and 29%, respectively. Twenty-two percent of the patients had been previously shunted. The 1- and 5-year success rates were 65 and 52%, respectively. Factors included in the Cox model were age, sex, etiology of hydrocephalus, previous surgery, center volume, and surgeon volume. By multivariate analysis, only age had a significant effect on outcome, with younger patients failing at higher rates, particularly neonates and infants. CONCLUSION: Based on data from multiple Canadian centers, age seems to be the primary determinant of outcome in endoscopic third ventriculostomy in pediatric patients. Failure rates are particularly high in neonates and young infants; thus, the role of this procedure in this age group should be carefully considered.
OBJECTIVE: Reports from relatively small series of pediatric patients predominantly from single centers have hampered accurate analysis of outcome from endoscopic third ventriculostomy. We combined patients from nine pediatric neurosurgery centers across Canada to obtain a better estimate of outcome and identify factors affecting success of the procedure. METHODS: Databases were recoded for uniformity. Failure of the procedure was defined as any subsequent operation or death resulting from hydrocephalus. Time to failure was analyzed by Kaplan-Meier estimate and Cox proportional hazard analysis. RESULTS: During a 15-year period (1989-2004), 368 patients underwent the procedure. The average age was 6.5 years, and 57% were male. Aqueduct stenosis and tumors were the most common etiology, comprising 34 and 29%, respectively. Twenty-two percent of the patients had been previously shunted. The 1- and 5-year success rates were 65 and 52%, respectively. Factors included in the Cox model were age, sex, etiology of hydrocephalus, previous surgery, center volume, and surgeon volume. By multivariate analysis, only age had a significant effect on outcome, with younger patients failing at higher rates, particularly neonates and infants. CONCLUSION: Based on data from multiple Canadian centers, age seems to be the primary determinant of outcome in endoscopic third ventriculostomy in pediatric patients. Failure rates are particularly high in neonates and young infants; thus, the role of this procedure in this age group should be carefully considered.
Authors: José Aloysio Costa Val; Paulo Mallard Scaldaferri; Leopoldo Mandic Furtado; Guilherme de Souza Baptista Journal: Childs Nerv Syst Date: 2012-06-29 Impact factor: 1.475
Authors: Leopoldo Mandic Ferreira Furtado; José Aloysio da Costa Val Filho; Eustaquio Claret Dos Santos Júnior Journal: Neurosurg Rev Date: 2021-01-03 Impact factor: 3.042