title: Endoscopic Third Ventriculostomy Instead of Shunt Revision in Children Younger Than 3 Years of Age.
abstract: OBJECTIVE
  Endoscopic third ventriculostomy (ETV) is a valuable option in the treatment of shunt failure, but no clinical data exist for young children. The aim of this study was to elucidate the role of ETV in patients younger than 3 years of age with shunt malfunction.
  
  
  METHODS
  A cohort of 37 patients younger than 3 years of age with shunt malfunction underwent ETV instead of shunt revision. Patients' preoperative condition and medical history were studied to determine the impact of a number of variables on outcome. The Fisher exact test was used to assess differences among groups.
  
  
  RESULTS
  Median age at ETV was 21.6 months (8-36 months). Diagnosis was obstructive hydrocephalus in 24 patients and communicating hydrocephalus in 13. Median age at initial shunt placement was 3.2 months (10 days to 30 months). The etiology of shunt malfunction was obstruction (n = 27) or infection (n = 10). Overall ETV failure rate was 40.5% (15/37). Patients whose age at initial shunt placement was <6 months and/or who had a preterm birth history had higher relative rates of ETV failure. Other variables, including type of hydrocephalus, interval between initial shunt placement and ETV, history of intraventricular bleeding and/or infection, and etiology of shunt malfunction, did not significantly affect the final outcome.
  
  
  CONCLUSIONS
  Patients younger than 3 years with obstructive or communicating hydrocephalus may benefit from ETV in the event of shunt malfunction and have about a 60% probability of becoming shunt free.
authors.affiliation: Department of Pediatric Neurosurgery, Children's Hospital of Fudan University, Shanghai, P.R. China.
authors.forename: Rui
authors.initials: R
authors.lastname: Zhao
authors.affiliation: Department of Pediatric Neurosurgery, Children's Hospital of Fudan University, Shanghai, P.R. China.
authors.forename: Wei
authors.initials: W
authors.lastname: Shi
authors.affiliation: Department of Radiology, Children's Hospital of Fudan University, Shanghai, P.R. China.
authors.forename: Haowei
authors.initials: H
authors.lastname: Yang
authors.affiliation: Department of Pediatric Neurosurgery, Children's Hospital of Fudan University, Shanghai, P.R. China. Electronic address: lihao7272@163.com.
authors.forename: Hao
authors.initials: H
authors.lastname: Li
mesh_terms: D002675:Child, Preschool; D020878:Device Removal / Q000379:methods; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000473:pathology* / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D044583:Neuroendoscopy / Q000379:methods*; D011475:Prosthesis Failure; D012086:Reoperation / Q000379:methods; D020542:Third Ventricle / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt / Q000295:instrumentation / Q000379:methods*; D014696:Ventriculostomy / Q000379:methods*
keywords: Endoscopic third ventriculostomy; Hydrocephalus; Pediatric; Ventriculoperitoneal shunt failure