Document Detail


Endoscopic third ventriculostomy vs cerebrospinal fluid shunt in the treatment of hydrocephalus in children: a propensity score-adjusted analysis.
MedLine Citation:
PMID:  20647973     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
BACKGROUND: Endoscopic third ventriculostomy (ETV) has preferentially been offered to patients with more favorable prognostic features compared with shunt.
OBJECTIVE: To use advanced statistical methods to adjust for treatment selection bias to determine whether ETV survival is superior to shunt survival once the bias of patient-related prognostic factors is removed.
METHODS: An international cohort of children (< or = 19 years of age) with newly diagnosed hydrocephalus treated with ETV (n = 489) or shunt (n = 720) was analyzed. We used propensity score adjustment techniques to account for 2 important patient prognostic factors: age and cause of hydrocephalus. Cox regression survival analysis was performed to compare time-to-treatment failure in an unadjusted model and 3 propensity score-adjusted models, each of which would adjust for the imbalance in prognostic factors.
RESULTS: In the unadjusted Cox model, the ETV failure rate was lower than the shunt failure rate from the immediate postoperative phase and became even more favorable with longer duration from surgery. Once patient prognostic factors were corrected for in the 3 adjusted models, however, the early failure rate for ETV was higher than that for shunt. It was only after about 3 months after surgery did the ETV failure rate become lower than the shunt failure rate.
CONCLUSIONS: The relative risk of ETV failure is initially higher than that for shunt, but after about 3 months, the relative risk becomes progressively lower for ETV. Therefore, after the early high-risk period of ETV failure, a patient could experience a long-term treatment survival advantage compared with shunt. It might take several years, however, to realize this benefit.
Authors:
Abhaya V Kulkarni; James M Drake; John R W Kestle; Conor L Mallucci; Spyros Sgouros; Shlomi Constantini;
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  67     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-08-23     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  588-93     Citation Subset:  IM    
Affiliation:
Division of Neurosurgery, Hospital for Sick Children, Room 1503, 555 University Ave, Toronto, Ontario, Canada M5G 1X8. abhaya.kulkarni@sickkids.ca
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MeSH Terms
Descriptor/Qualifier:
Investigator
Investigator/Affiliation:
P B Dirks / ; J M Drake / ; A V Kulkarni / ; J T Rutka / ; A Van der Stoel / ; I Veltman / ; D D Cochrane / ; P Steinbok / ; K Aronyk / ; V Mehta / ; J Atkinson / ; J P Farmer / ; J Montes / ; W Hader / ; M Hamilton / ; M Vassilyadi / ; E Ventureyra / ; A Ranger / ; P J McDonald / ; W Howes / ; P D McNeely / ; S A Walling /

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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