Artikel
Influence factors on endoscopic third ventriculostomy – outcome analysis and comparison of two German neuroendoscopy centers
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Autoren
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Sonja Vulcu
- Universitätsklinikum des Saarlandes, Neurochirurgische Klinik, Homburg/Saar; Inselspital Bern, Neurochirurgische Klinik, Bern/Schweiz
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Ömer Bozcicek
- Universitätsklinikum des Saarlandes, Neurochirurgische Klinik, Homburg/Saar
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Wolfgang Wagner
- Universitätsmedizin Mainz, Neurochirurgische Klinik, Mainz
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Michael R. Gaab
- KRH Klinikum Nordstadt, Neurochirurgische Klinik, Hannover
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Joachim Oertel
- Universitätsklinikum des Saarlandes, Neurochirurgische Klinik, Homburg/Saar
| Veröffentlicht: | 2. Juni 2015 |
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Gliederung
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Objective: The endoscopic third ventriculostomy presents the procedure of first choice in the therapy of obstructive hydrocephalus. There exists a stable and high success rate for this procedure; and the impact of age and etiology is notorious. Other influence factors are still under current debate. The authors evaluated potential new influence factors on the outcome rate after ETV and compared the results of two German neuroendoscopy centers in a large patient series.
Method: The authors performed a retrospective analysis of 250 patients who underwent an endoscopic third ventriculostomy between 2006 and 2008 either at department A or B. Evaluation was based on patient records, surgical records, telephone interviews and follow-up examinations. Analyzed factors were age, underlying pathology, endoscopic system and surgical experience. Surgical success was defined by complication rate, revision rate and clinical/radiological outcome.
Results: One-hundred-seventeen patients received an ETV at department A and 133 patients at department B. The patient collectives were slightly different with more infants at department B. Postoperative clinical success rate reached 79.3% at department A and 68.7% at department B. There was a significant influence on clinical success for age (p=0.031) and underlying pathology (p=0.000). Intraoperative complications occurred in 5.6% and postoperative complications in 9.2% of the patients. Age (p=0.026) and surgical experience (p=0.029) had a significant impact on intraoperative complication rate. Furthermore, there was a significant influence on the revision rate for the underlying pathology (p=0.037). A revision surgery was performed in 12% of the patients. Surgical experience and endoscopic equipment had no significant impact on the clinical success rate.
Conclusions: The evaluation of these patient collectives underlines the importance of impact factors like age and hydrocephalus etiology for clinical success. Surgical experience and persistence of surgical technique seem to play an important role to avoid intraoperative complications.
