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

the 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

the Hydrocephalus Clinical Research Network

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

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.

Original language	English
Pages (from-to)	8-17
Number of pages	10
Journal	Journal of Neurosurgery: Pediatrics
Volume	30
Issue number	1
DOIs	https://doi.org/10.3171/2022.3.PEDS224
State	Published - Jul 2022

Keywords

ETV revision
Hydrocephalus Clinical Research Network
endoscopic third ventriculostomy and choroid plexus cauterization
hydrocephalus

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10.3171/2022.3.PEDS224

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@article{452c2cdc9aa546ba983f15f4db66ea2c,

title = "Endoscopic third ventriculostomy revision after failure of initial endoscopic third ventriculostomy and choroid plexus cauterization",

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",

author = "{the Hydrocephalus Clinical Research Network} and Anastasia Arynchyna-Smith and Rozzelle, {Curtis J.} and Hailey Jensen and Reeder, {Ron W.} and Kulkarni, {Abhaya V.} and Pollack, {Ian F.} and Wellons, {John C.} and Naftel, {Robert P.} and Jackson, {Eric M.} and Whitehead, {William E.} and Pindrik, {Jonathan A.} and Limbrick, {David D.} and McDonald, {Patrick J.} and Tamber, {Mandeep S.} and O'Neill, {Brent R.} and Hauptman, {Jason S.} and Krieger, {Mark D.} and Jason Chu and Simon, {Tamara D.} and Jay Riva-Cambrin and Kestle, {John R.W.} and Rocque, {Brandon G.} and D. Brockmeyer and M. Walker and R. Bollo and S. Cheshier and J. Blount and J. Johnston and L. Acakpo-Satchivi and Oakes, {W. J.} and P. Dirks and J. Rutka and M. Taylor and P. Dirks and D. Curry and G. Aldave and R. Dauser and A. Jea and S. Lam and H. Weiner and T. Luerssen and R. Ellenbogen and J. Ojemann and A. Lee and A. Avellino and S. Greene and E. Tyler-Kabara and T. Abel and Park, {T. S.} and J. Strahle and S. McEvoy and M. Smyth and N. Tulipan and A. Singhal and P. Steinbok and D. Cochrane and W. Hader and C. Gallagher and M. Benour and E. Kiehna and McComb, {J. G.} and P. Chiarelli and A. Robison and A. Alexander and M. Handler and T. Hankinson and C. Wilkinson and L. Governale and A. Drapeau and J. Leonard and E. Sribnick and A. Shaikhouni and E. Ahn and A. Cohen and M. Groves and S. Robinson and Bonfield, {C. M.} and C. Shannon and L. Holman and J. Clawson and P. Martello and N. Tattersall and T. Bach and T. Caudill and P. Komarova and A. Bey and H. Ashrafpour and M. Lamberti-Pasculli and L. O'Connor and E. Santisbon and E. Sanchez and S. Martinez and S. Ryan and K. Hall and C. Gangan and J. Klein and A. Anderson and G. Bowen and S. Thambireddy and K. Diamond and A. Luther and A. Morgan and H. Botteron and D. Morales and M. Gabir and D. Berger and D. Mercer and M. Stone and A. Wiseman and J. Stoll and D. Dawson and S. Gannon and A. Cheong and R. Hengel and R. Rashid and S. Ahmed and J. Yea and A. Loudermilk and N. Chapman and N. Rea and C. Cook and S. Staulcup and S. Saraswat and A. Sheline and N. Nunn and M. Langley and V. Wall and D. Austin and B. Conley and V. Freimann and L. Herrera and B. Miller",

note = "Publisher Copyright: {\textcopyright} AANS 2022, except where prohibited by US copyright law",

year = "2022",

month = jul,

doi = "10.3171/2022.3.PEDS224",

language = "English",

volume = "30",

pages = "8--17",

journal = "Journal of Neurosurgery: Pediatrics",

issn = "1933-0707",

number = "1",

}

TY - JOUR

T1 - Endoscopic third ventriculostomy revision after failure of initial endoscopic third ventriculostomy and choroid plexus cauterization

AU - the Hydrocephalus Clinical Research Network

AU - Arynchyna-Smith, Anastasia

AU - Rozzelle, Curtis J.

AU - Jensen, Hailey

AU - Reeder, Ron W.

AU - Kulkarni, Abhaya V.

AU - Pollack, Ian F.

AU - Wellons, John C.

AU - Naftel, Robert P.

AU - Jackson, Eric M.

AU - Whitehead, William E.

AU - Pindrik, Jonathan A.

AU - Limbrick, David D.

AU - McDonald, Patrick J.

AU - Tamber, Mandeep S.

AU - O'Neill, Brent R.

AU - Hauptman, Jason S.

AU - Krieger, Mark D.

AU - Chu, Jason

AU - Simon, Tamara D.

AU - Riva-Cambrin, Jay

AU - Kestle, John R.W.

AU - Rocque, Brandon G.

AU - Brockmeyer, D.

AU - Walker, M.

AU - Bollo, R.

AU - Cheshier, S.

AU - Blount, J.

AU - Johnston, J.

AU - Acakpo-Satchivi, L.

AU - Oakes, W. J.

AU - Dirks, P.

AU - Rutka, J.

AU - Taylor, M.

AU - Dirks, P.

AU - Curry, D.

AU - Aldave, G.

AU - Dauser, R.

AU - Jea, A.

AU - Lam, S.

AU - Weiner, H.

AU - Luerssen, T.

AU - Ellenbogen, R.

AU - Ojemann, J.

AU - Lee, A.

AU - Avellino, A.

AU - Greene, S.

AU - Tyler-Kabara, E.

AU - Abel, T.

AU - Park, T. S.

AU - Strahle, J.

AU - McEvoy, S.

AU - Smyth, M.

AU - Tulipan, N.

AU - Singhal, A.

AU - Steinbok, P.

AU - Cochrane, D.

AU - Hader, W.

AU - Gallagher, C.

AU - Benour, M.

AU - Kiehna, E.

AU - McComb, J. G.

AU - Chiarelli, P.

AU - Robison, A.

AU - Alexander, A.

AU - Handler, M.

AU - Hankinson, T.

AU - Wilkinson, C.

AU - Governale, L.

AU - Drapeau, A.

AU - Leonard, J.

AU - Sribnick, E.

AU - Shaikhouni, A.

AU - Ahn, E.

AU - Cohen, A.

AU - Groves, M.

AU - Robinson, S.

AU - Bonfield, C. M.

AU - Shannon, C.

AU - Holman, L.

AU - Clawson, J.

AU - Martello, P.

AU - Tattersall, N.

AU - Bach, T.

AU - Caudill, T.

AU - Komarova, P.

AU - Bey, A.

AU - Ashrafpour, H.

AU - Lamberti-Pasculli, M.

AU - O'Connor, L.

AU - Santisbon, E.

AU - Sanchez, E.

AU - Martinez, S.

AU - Ryan, S.

AU - Hall, K.

AU - Gangan, C.

AU - Klein, J.

AU - Anderson, A.

AU - Bowen, G.

AU - Thambireddy, S.

AU - Diamond, K.

AU - Luther, A.

AU - Morgan, A.

AU - Botteron, H.

AU - Morales, D.

AU - Gabir, M.

AU - Berger, D.

AU - Mercer, D.

AU - Stone, M.

AU - Wiseman, A.

AU - Stoll, J.

AU - Dawson, D.

AU - Gannon, S.

AU - Cheong, A.

AU - Hengel, R.

AU - Rashid, R.

AU - Ahmed, S.

AU - Yea, J.

AU - Loudermilk, A.

AU - Chapman, N.

AU - Rea, N.

AU - Cook, C.

AU - Staulcup, S.

AU - Saraswat, S.

AU - Sheline, A.

AU - Nunn, N.

AU - Langley, M.

AU - Wall, V.

AU - Austin, D.

AU - Conley, B.

AU - Freimann, V.

AU - Herrera, L.

AU - Miller, B.

PY - 2022/7

Y1 - 2022/7

N2 - 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.

AB - 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.

KW - ETV revision

KW - Hydrocephalus Clinical Research Network

KW - endoscopic third ventriculostomy and choroid plexus cauterization

KW - hydrocephalus

UR - http://www.scopus.com/inward/record.url?scp=85133950395&partnerID=8YFLogxK

U2 - 10.3171/2022.3.PEDS224

DO - 10.3171/2022.3.PEDS224

M3 - Article

C2 - 35453104

AN - SCOPUS:85133950395

SN - 1933-0707

VL - 30

SP - 8

EP - 17

JO - Journal of Neurosurgery: Pediatrics

JF - Journal of Neurosurgery: Pediatrics

IS - 1

ER -

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

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