title: Factors affecting surgical outcome of endoscopic third ventriculostomy in congenital hydrocephalus.
abstract: Endoscopic third ventriculostomy (ETV) is an accepted modality of treatment for obstructive hydrocephalus, with good results in adult patients. However in the pediatric age group results vary from poor to similar to the adult population. This study evaluates the outcome of ETV in congenital hydrocephalus of both early and delayed presentation, and investigates factors that determine the outcome. Patients with congenital hydrocephalus who underwent ETV between January 2006 and December 2011 were retrospectively analyzed. Any conditions potentially influencing the need for redo surgery (persistent cerebrospinal fluid [CSF] leak not responding to local measures, tense fontanelle, increased ventricular size, recurrence of symptoms or radiological evidence of failure) were analyzed. A total of 102 patients with a mean age of 7.45years were included. Presenting features were increasing head circumference and delayed milestones. Ninety-eight patients had triventricular hydrocephalus due to aqueductal stenosis. Procedures performed were ETV only (n=74), ETV with aqueductoplasty (n=22), ETV with cystoventriculostomy (n=2) and aqueductoplasty only (n=2). Failure of ETV occurred in 11 patients and all were managed with a ventriculoperitoneal shunt. CSF leak in the perioperative period was the only factor that was significantly associated with failure of ETV. ETV is a safe procedure with a good success rate and can be offered to children with aqueductal stenosis. There is a higher chance of failure if there is a CSF leak in the early or late postoperative period.
authors.affiliation: Department of Neurosurgery, Neurosciences Center, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
authors.forename: Ajay
authors.initials: A
authors.lastname: Bisht
authors.affiliation: Department of Neurosurgery, Neurosciences Center, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India. Electronic address: surineuro@gmail.com.
authors.forename: Ashish
authors.initials: A
authors.lastname: Suri
authors.affiliation: Department of Neurosurgery, Neurosciences Center, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
authors.forename: Sumit
authors.initials: S
authors.lastname: Bansal
authors.affiliation: Department of Neurosurgery, Neurosciences Center, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
authors.forename: P Sarat
authors.initials: PS
authors.lastname: Chandra
authors.affiliation: Department of Neurosurgery, Neurosciences Center, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
authors.forename: Rajinder
authors.initials: R
authors.lastname: Kumar
authors.affiliation: Department of Neurosurgery, Neurosciences Center, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
authors.forename: Manmohan
authors.initials: M
authors.lastname: Singh
authors.affiliation: Department of Neurosurgery, Neurosciences Center, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
authors.forename: Bhawani Shankar
authors.initials: BS
authors.lastname: Sharma
mesh_terms: D065634:Cerebrospinal Fluid Leak / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000473:pathology / Q000601:surgery*; D007223:Infant; D008297:Male; D044583:Neuroendoscopy / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D020542:Third Ventricle / Q000601:surgery*; D016896:Treatment Outcome; D014696:Ventriculostomy / Q000379:methods*
keywords: Aqueductal stenosis; Congenital; Endoscopic third ventriculostomy; Hydrocephalus