Artikel
Probability of shunt independence after endoscopic third ventriculostomy
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Autoren
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J. Baldauf
- Klinik für Neurochirurgie, Universitätsklinikum Greifswald
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U. Dillger
- Klinik für Neurochirurgie, Universitätsklinikum Greifswald
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J. Oertel
- Klinik für Neurochirurgie, Universitätsklinikum Mainz
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M.R. Gaab
- Klinik für Neurochirurgie, Nordstadt Krankenhaus, Hannover
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H.W.S. Schroeder
- Klinik für Neurochirurgie, Universitätsklinikum Greifswald
| Veröffentlicht: | 20. Mai 2009 |
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Gliederung
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Objective: Endoscopic third ventriculostomy (ETV) is an alternative approach in the treatment of different etiologies of hydrocephalus compared to procedures of ventricular shunting. Still, discrepancies exist whether shunt independence is secured for years or decades.
Methods: Between 1993 and 2008 266 ETV’s were performed at our department. The data of all patients were prospectively collected. Our recent study included only adults treated with ETV between 1993 and 2002 with a follow-up of approximately 5 years. If still alive, these patients were asked to come to a new clinical and imaging analysis. Statistical calculations regarding long-term probability of shunt independence after ETV were made of all these patients.
Results: There were 142 patients, 71 male and 71 female with an average age of 52.3 years (range 18–84). Etiologies of hydrocephalus consisted of tumor related origin (68), aqueductal stenosis (25), posthemorrhagic (18), cerebellar infarction (8), related to aneurysms (4), to intraparenchymal cysts (2), MMC (1), isolated 4th ventricle (1) and communicating hydrocephalus (15). To date 67 patients have died, 43 were currently seen, 11 have received a shunt and 23 patients have been lost for follow-up. Mean follow-up was 4.3 years (range 0 to 14 years). Six re-ETV’s were performed in 5 patients (after 3 months to 4.5 years). Four of them were successful (80%). Eight of the shunted patients received the shunt within 4 months after ETV. ETV was successful with respect to shunt independence in 92.3%. Patients with a communicating hydrocephalus demonstrated the lowest success rate (46.7%). In contrast, patients with an aqueductal stenosis revealed a success rate of 92% and tumor related hydrocephalus of 98.5%. Kaplan-Meier plots for all patients demonstrated a probability of shunt independence after 5 years of 93.7%. A probability of shunt independence after 5 years in case of a tumor related hydrocephalus was 98.5%, for an aqueductal stenosis 92%.
Conclusions: Our success rate of ETV regarding shunt independence was 92.3% with a probability of shunt independence after 5 years of 93.7%. The results underline that ETV is the procedure of choice for the treatment of occlusive hydrocephalus.
