Prediction of endoscopic third ventriculostomy (ETV) success with preoperative third ventricle floor bowing (TVFB): a su
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ORIGINAL ARTICLE
Prediction of endoscopic third ventriculostomy (ETV) success with preoperative third ventricle floor bowing (TVFB): a supplement to ETV success score Qiguang Wang 1 & Jian Cheng 1 & Si Zhang 1 & Qiang Li 1 & Xuhui Hui 1 & Yan Ju 1 Received: 20 June 2019 / Revised: 23 August 2019 / Accepted: 4 September 2019 # Springer-Verlag GmbH Germany, part of Springer Nature 2019
Abstract Preoperative judgement of which children is likely to benefit from endoscopic third ventriculostomy (ETV) is still the most difficult challenge. This study aimed to compare the efficiency of third ventricular floor bowing (TVFB) and ETV success score (ETVSS) in selecting ETV candidates and achieve a better preoperative patient selection method for ETV based on our institutional experience. Children (≤ 16 years old) with newly diagnosed hydrocephalus treated with ETV between January 2013 and June 2018 were included in this prospective study. Patients with TVFB will receive ETV procedure in the pediatric subgroup of our department. ETVSS was calculated in every patient. The ETVSS predicted ETV success rate and the actual ETV success rate in our institution were compared and further analyzed. One hundred twenty-nine children with TVFB were enrolled in our study. The mean age at ETV was 5.84 ± 5.17 years (range, 0.04–16). Brain tumors, aqueductal stenosis, and inflammatory are the most common hydrocephalus etiologies. The most common complication was noninfectious fever (3.1%). During the average followup of 19.5 ± 14.95 months, twenty-five patients had depicted ETV failure. The actual ETV success rate (81%) in our study was higher than the success rate (69%) predicted by ETVSS. TVFB is a pragmatic, efficient, and simple model to predict the ETV outcome. We suggest that for hydrocephalic patients with preoperative third ventricular floor bowing, ETV should be the firsttreatment choice regardless of the ETV success score. And for patients without such sign, ETVSS should be applied to select ETV candidates. Keywords Endoscopic third ventriculostomy . Third ventricle floor . ETV success score . Outcome
Introduction Hydrocephalus is a very common disease in pediatric neurosurgery. Treatment alternatives primarily include endoscopic third ventriculostomy (ETV) and CSF shunting [7]. Due to the lower long-term complication rate compared with CSF shunting, ETV has acquired great applicability in pediatric hydrocephalus in recent years [11]. However, preoperative judgement of which children are likely to benefit from ETV is still the most difficult challenge. In order to make the preoperative decision more effectively, various researches had tried to define the radiographic and * Yan Ju [email protected] 1
Department of Neurosurgery, West China Hospital of Sichuan University, 37 Guo Xue Xiang, Wu Hou District, Chengdu 610041, Sichuan, China
clinical parameters to clarify the indications of ETV. Kulkarni et al. [11] proposed ETV success score (ETVSS) based on the clinical factors such as age, etiology of hydrocephalus, and previous shu
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