Artikel
ETV in infancy and childhood below 2 years of age
Endoskopische Drittventrikulostomie in Kindern unter 2 Jahren
Suche in Medline nach
Autoren
-
Ahmed El Damaty
- Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland
-
Sascha Marx
- Universitätsmedizin Greifswald, Klinik für Neurochirurgie, Greifswald, Deutschland
-
Gesa Cohrs
- Universitätsklinikum Schleswig-Holstein, Klinik für Neurochirurgie, Kiel, Deutschland
-
Ehab EL Refaee
- Universitätsmedizin Greifswald, Klinik für Neurochirurgie, Greifswald, Deutschland; Cairo University, Department of Neurosurgery, Kairo, Egypt
-
Joerg Baldauf
- Universitätsmedizin Greifswald, Klinik für Neurochirurgie, Greifswald, Deutschland
-
Steffen Fleck
- Universitätsmedizin Greifswald, Klinik für Neurochirurgie, Greifswald, Deutschland
-
Heidi Bächli
- Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland
-
Ahmed Zohdi
- Cairo University, Department of Neurosurgery, Kairo, Egypt
-
Michael Synowitz
- Universitätsklinikum Schleswig-Holstein, Klinik für Neurochirurgie, Kiel, Deutschland
-
Andreas W. Unterberg
- Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland
-
Henry W. S. Schroeder
- Universitätsmedizin Greifswald, Klinik für Neurochirurgie, Greifswald, Deutschland
| Veröffentlicht: | 26. Juni 2020 |
|---|
Gliederung
Text
Objective: Endoscopic third ventriculostomy (ETV) has become the method of choice in the treatment of obstructive hydrocephalus. Age and etiology could determine success rates of ETV. The outcome is worse in children <2 years of age, and controversies still exist whether ETV is superior to shunt placement in this age group. We retrospectively analyzed the data of 70 patients <24 months of age from 4 different university centers treated with ETV and assessed its feasibility as a treatment for hydrocephalus.
Methods: We included all children <2 years of age who received ETV as a treatment for obstructive hydrocephalus regardless of the etiology within the time period from December 1994 till December 2018. Cases were collected from 4 surgical centers. We classified the patients according to age and etiology; 3 age groups: <3, 4-12 and 13-24 months. Etiologically there were 6 groups; idiopathic aqueductal stenosis, post-hemorrhagic hydrocephalus (PHH), tumor-related hydrocephalus, fourth ventricle outflow obstruction, with Chiari malformation type II and following CSF infection.
Results: We collected 70 patients. ETV was successful in 41.4% (29/70). ETV was successful in tumor-related hydrocephalus in 62.5% (5/8), fourth ventricle outlet obstruction in 60% (3/5), aqueductal stenosis in 44% (11/25), PHH in 40.9% (9/22), Chiari Type II in 16.7% (1/6) and none with post-infection hydrocephalus (0/4). According to age groups, the first age group (below 3 months age) showed success rate 33.3%, second age group (4-12 months) with 46.4% and third age group (13-24 months) with 46.6%.
Conclusion: Factors suggesting a high possibility of failure were age <3 months and etiology such as Chiari malformation type II or following CSF infection. ETV is the method of choice in patients with obstructive hydrocephalus. Altered CSF dynamics in patients with PHH and under-developed arachnoid villi may play a role in ETV failure. We still recommend ETV to be the first line of treatment even in children <3 months of age depending on the etiology.
