title: Endoscopic third ventriculocisternostomy in hydrocephalic children under 2 years of age: appropriate or not? A single-center retrospective cohort study.
abstract: OBJECTIVE
  Treating hydrocephalus can be difficult in children under the age of 2 years because a high amount of uncertainty exists as to which treatment to perform. In this retrospective cohort study, we analyzed children under the age of 2 years with hydrocephalus undergoing an endoscopic third ventriculocisternostomy (ETV) with respect to ETV outcome.
  
  
  METHODS
  In 59 consecutive patients under the age of 2 years, an ETV was performed between 1999 and 2010 at the Erasmus MC, Sophia Children's Hospital. Demographics, etiology of hydrocephalus, and radiological data were extracted retrospectively from the patients' medical records and operative reports and related to outcome. ETV Success Score (ETVSS) was used to retrospectively calculate the probability of success related to the actual outcome.
  
  
  RESULTS
  In this series, 42.4 % of patients had a successful ETV. The only statistically significant finding concerned age. The failed ETV patients appeared to be younger (0.52 ± 0.60 vs. 0.86 ± 0.56 year, p = 0.005), and when using a cutoff age of 6 months only, five out of 32 infants had a successful ETV (p = 0.002). Of the children with an arachnoid cyst, 57.1 % were treated successfully with an ETV. Of the five patients with a high probability of ETV success, four (80 %) were indeed successfully treated with ETV (p = 0.049).
  
  
  CONCLUSIONS
  Our data confirm the overall ineffectiveness of an ETV in children under the age of 6 months. Nevertheless, using the ETVSS is recommended to aid in the decision-making process even in patients under the age of 6 months.
authors.affiliation: Department of Pediatric Neurosurgery, Erasmus MC, Sophia Children's Hospital, Dr. Molewaterplein 60, Sk 1204, PO Box 2060, 3000 Rotterdam, The Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: Fani
authors.forename: T H R
authors.initials: TH
authors.lastname: de Jong
authors.forename: R
authors.initials: R
authors.lastname: Dammers
authors.forename: M L C
authors.initials: ML
authors.lastname: van Veelen
mesh_terms: D000367:Age Factors; D002675:Child, Preschool; D015331:Cohort Studies; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery*; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D020542:Third Ventricle / Q000473:pathology / Q000601:surgery*; D014696:Ventriculostomy / Q000295:instrumentation* / Q000379:methods