Document Detail

Predicting who will benefit from endoscopic third ventriculostomy compared with shunt insertion in childhood hydrocephalus using the ETV Success Score.
MedLine Citation:
PMID:  20887100     Owner:  NLM     Status:  MEDLINE    
OBJECT: The authors recently developed and internally validated the ETV Success Score (ETVSS)--a simplified means of predicting the 6-month success rate of endoscopic third ventriculostomy (ETV) for a child with hydrocephalus, based on age, etiology of hydrocephalus, and presence of a previous shunt. A high ETVSS predicts a high chance of early ETV success. In this paper, they assess the clinical utility of the ETVSS by determining whether long-term survival outcomes for ETV versus shunt insertion are different within strata of ETVSS (low, moderate, and high scores).
METHODS: A multicenter, international cohort of children (≤ 19 years old) with newly diagnosed hydrocephalus treated with either ETV (489 patients) or shunt insertion (720 patients) was analyzed. The ETVSS was calculated for all patients. Survival analyses with time-dependent modeling of the hazard ratios were performed.
RESULTS: For the High-ETVSS Group (255 ETV-treated patients, 117 shunt-treated patients), ETV appeared to have a lower risk of failure right from the early postoperative phase and became more favorable with time. For the Moderate-ETVSS Group (172 ETV-treated patients, 245 shunt-treated patients), ETV appeared to have a higher initial failure rate, but after about 3 months the instantaneous risk of ETV failure became slightly lower than shunt failure (that is, the hazard ratio became < 1). For the Low-ETVSS Group (62 ETV-treated patients, 358 shunt-treated patients), the early risk of ETV failure was much higher than the risk of shunt failure, but the instantaneous risk of ETV failure became lower than the risk of shunt failure at about 6 months following surgery (the hazard ratio became < 1).
CONCLUSIONS: Across all ETVSS strata, the risk of ETV failure becomes progressively lower compared with the risk of shunt failure with increasing time from the surgery. In the best ETV candidates (ETVSS ≥ 80), however, the risk of ETV failure is lower than the risk of shunt failure very soon after surgery, while for less-than-ideal ETV candidates (ETVSS ≤ 70), the risk of ETV failure is initially higher than the risk of shunt failure and only becomes lower after 3-6 months from surgery. These results need to be confirmed by larger, prospective, and preferably randomized studies.
Abhaya V Kulkarni; James M Drake; John R W Kestle; Conor L Mallucci; Spyros Sgouros; Shlomi Constantini;
Publication Detail:
Type:  Journal Article; Multicenter Study    
Journal Detail:
Title:  Journal of neurosurgery. Pediatrics     Volume:  6     ISSN:  1933-0715     ISO Abbreviation:  J Neurosurg Pediatr     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-10-04     Completed Date:  2010-10-25     Revised Date:  2011-10-17    
Medline Journal Info:
Nlm Unique ID:  101463759     Medline TA:  J Neurosurg Pediatr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  310-5     Citation Subset:  IM    
Hospital for Sick Children, Toronto, Canada.
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MeSH Terms
Cerebrospinal Fluid Shunts / mortality*
Child, Preschool
Hydrocephalus* / mortality,  pathology,  surgery
Infant, Newborn
Kaplan-Meier Estimate
Predictive Value of Tests
Proportional Hazards Models
Risk Factors
Severity of Illness Index
Third Ventricle / pathology*,  surgery*
Ventriculostomy / mortality*
W Hader / ; M Hamilton / ; D D Cochrane / ; P Steinbok / ; M Vassilyadi / ; E Ventureyra / ; P B Dirks / ; J M Drake / ; A V Kulkarni / ; J T Rutka / ; A Van der Stoel / ; I Veltman / ; W Howes / ; P D McNeely / ; S A Walling / ; A Ranger / ; J Atkinson / ; J P Farmer / ; J Montes / ; K Aronyk / ; V Mehta / ; P J McDonald /
Comment In:
J Neurosurg Pediatr. 2010 Oct;6(4):307-9; discussion 309   [PMID:  20887099 ]
Erratum In:
J Neurosurg Pediatr. 2011 Feb;7(2):221
J Neurosurg Pediatr. 2011 Feb;7(2):221   [PMID:  21284473 ]

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