Prospective, multicenter results of endoscopic third ventriculostomy in children
Investigators from the Hydrocephalus Clinical Research Network (HCRN) present the results of 336 patients who underwent endoscopic third ventriculostomy (ETV) between 2008 and 2013. Clinical and intraoperative data were collected prospectively, with minimum follow-up of 18 months. ETV failure was defined as any need for repeat hydrocephalus surgery. Average patient age was 6.9 years, with 15% of patients under 12 months of age at surgery. The most common hydrocephalus etiologies were aqueductal stenosis (25%) and tectal tumor (21%). Most ETV failures occurred within 6 months of surgery (117 of 141 failures). Kaplan-Meier event-free ETV survival at 1 year was 62%. Multivariate analysis showed that preoperative ETV success score (ETVSS) and intraop visualization of the “naked basilar artery” were independently associated with ETV success. The most common reported complication was visible forniceal injury (17%), with other complications rare. This prospective cohort study is the largest ETV experience in North America. Reported success rates were similar to prediction by preoperative ETVSS. The rate of forniceal injury was higher than expected, and although no associated neurologic deficit were reported, long term follow up for subtle cognitive deficits is important.