Endoscopic third ventriculostomy revision after failure of initial endoscopic third ventriculostomy and choroid plexus cauterization

Anastasia Arynchyna-Smith; Curtis J Rozzelle; Hailey Jensen; Ron W Reeder; Abhaya V Kulkarni; Ian F Pollack; John C Wellons; Robert P Naftel; Eric M Jackson; William E Whitehead; Jonathan A Pindrik; David D Limbrick; Patrick J McDonald; Mandeep S Tamber; Brent R O'Neill; Jason S Hauptman; Mark D Krieger; Jason Chu; Tamara D Simon; Jay Riva-Cambrin; John R W Kestle; Brandon G Rocque; Hydrocephalus Clinical Research Network

doi:10.3171/2022.3.PEDS224

Endoscopic third ventriculostomy revision after failure of initial endoscopic third ventriculostomy and choroid plexus cauterization

J Neurosurg Pediatr. 2022 Apr 22;30(1):8-17. doi: 10.3171/2022.3.PEDS224. Print 2022 Jul 1.

Authors

Anastasia Arynchyna-Smith¹, Curtis J Rozzelle¹, Hailey Jensen², Ron W Reeder², Abhaya V Kulkarni³, Ian F Pollack⁴, John C Wellons⁵, Robert P Naftel⁵, Eric M Jackson⁶, William E Whitehead⁷, Jonathan A Pindrik⁸, David D Limbrick⁹, Patrick J McDonald¹⁰, Mandeep S Tamber¹⁰, Brent R O'Neill¹¹, Jason S Hauptman¹², Mark D Krieger¹³, Jason Chu¹³, Tamara D Simon¹⁴, Jay Riva-Cambrin¹⁵, John R W Kestle¹⁶, Brandon G Rocque¹; Hydrocephalus Clinical Research Network

Affiliations

¹ 1Department of Neurosurgery, Children's of Alabama, The University of Alabama at Birmingham, Birmingham, Alabama.
² Departments of2Pediatrics and.
³ 3Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada.
⁴ 4Department of Neurosurgery, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pennsylvania.
⁵ 5Department of Neurosurgery, Vanderbilt University Medical Center, and Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt University, Nashville, Tennessee.
⁶ 6Department of Neurosurgery, The Johns Hopkins Hospital, Johns Hopkins University, Baltimore, Maryland.
⁷ 7Department of Neurosurgery, Texas Children's Hospital, Houston, Texas.
⁸ 8Department of Neurosurgery, The Ohio State University College of Medicine, Columbus, Ohio.
⁹ 9Department of Neurosurgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
¹⁰ 10Division of Neurosurgery, British Columbia Children's Hospital, The University of British Columbia, Vancouver, British Columbia, Canada.
¹¹ 11Department of Neurosurgery, Children's Hospital Colorado, Colorado Springs, Colorado.
¹² 12Department of Neurosurgery, Seattle Children's Hospital, University of Washington, Seattle, Washington.
¹³ 13Department of Neurosurgery, Children's Hospital Los Angeles, University of Southern California, Los Angeles, California.
¹⁴ 14Department of Pediatrics, Children's Hospital Los Angeles, University of Southern California, Los Angeles, California; and.
¹⁵ 15Division of Neurosurgery, Alberta Children's Hospital, University of Calgary, Alberta, Canada.
¹⁶ 16Neurosurgery, University of Utah, Salt Lake City, Utah.

Abstract

Objective: Primary treatment of hydrocephalus with endoscopic third ventriculostomy (ETV) and choroid plexus cauterization (CPC) is well described in the neurosurgical literature, with wide reported ranges of success and complication rates. The purpose of this study was to describe the safety and efficacy of ETV revision after initial ETV+CPC failure.

Methods: Prospectively collected data in the Hydrocephalus Clinical Research Network Core Data Project registry were reviewed. Children who underwent ETV+CPC as the initial treatment for hydrocephalus between 2013 and 2019 and in whom the initial ETV+CPC was completed (i.e., not abandoned) were included. Log-rank survival analysis (the primary analysis) was used to compare time to failure (defined as any other surgical treatment for hydrocephalus or death related to hydrocephalus) of initial ETV+CPC versus that of ETV revision by using random-effects modeling to account for the inclusion of patients in both the initial and revision groups. Secondary analysis compared ETV revision to shunt placement after failure of initial ETV+CPC by using the log-rank test, as well as shunt failure after ETV+CPC to that after ETV revision. Cox regression analysis was used to identify predictors of failure among children treated with ETV revision.

Results: The authors identified 521 ETV+CPC procedures that met their inclusion criteria. Ninety-one children underwent ETV revision after ETV+CPC failure. ETV revision had a lower 1-year success rate than initial ETV+CPC (29.5% vs 45%, p < 0.001). ETV revision after initial ETV+CPC failure had a lower success rate than shunting (29.5% vs 77.8%, p < 0.001). Shunt survival after initial ETV+CPC failure was not significantly different from shunt survival after ETV revision failure (p = 0.963). Complication rates were similar for all examined surgical procedures (initial ETV+CPC, ETV revision, ventriculoperitoneal shunt [VPS] placement after ETV+CPC, and VPS placement after ETV revision). Only young age was predictive of ETV revision failure (p = 0.02).

Conclusions: ETV revision had a significantly lower 1-year success rate than initial ETV+CPC and VPS placement after ETV+CPC. Complication rates were similar for all studied procedures. Younger age, but not time since initial ETV+CPC, was a risk factor for ETV revision failure.

Keywords: ETV revision; Hydrocephalus Clinical Research Network; endoscopic third ventriculostomy and choroid plexus cauterization; hydrocephalus.

Grants and funding

RC1 NS068943/NS/NINDS NIH HHS/United States