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Endoscopic third ventriculostomy (ETV) or ventriculoperitoneal shunt (VPS) for paediatric hydrocephalus due to primary aqueductal stenosis

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Abstract

Purpose

The purpose of this study was to compare outcomes of endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunt (VPS) in children with symptomatic triventricular hydrocephalus due to primary aqueductal stenosis.

Method

This is a retrospective analytical study. Patients who underwent either ETV or VPS as the first procedure for hydrocephalus due to primary aqueductal stenosis were included in the study.

Result

A total of 89 children were included in the study for analysis. The mean age was 8.4 years. Forty-four (49.4%) had their first surgery as ETV and 45 (50.6%) had their first surgery as VPS. Overall, 34 (38.2%) patients required a second surgery (either ETV or VPS) for persistent or recurrent hydrocephalus. The mean follow-up duration was 832.9 days. The overall complication rate was 13.5%. The mean timing of the second surgery after index surgery was 601.35 days. Factors associated with a second surgery were the presence of complications, high protein in cerebrospinal fluid, the relative change of frontal-occipital horn ratio (FOHR) and Evans’ index. The survival of the first surgery was superior in ETV (751.55 days) compared to VPS (454.49 days), p = 0.013. The relative change of fronto-occipital horn index ratio (FOIR) was high in the VPS (mean 7.28%) group compared to the ETV (mean 4.40%), p = 0.001 group.

Conclusion

Overall procedural survival was better after ETV than VPS for hydrocephalus due to aqueductal stenosis. VPS causes more reduction in linear indices of ventricles as compared to ETV, however, is not associated with the success or complication of the procedure.

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Authors and Affiliations

  1. Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India

    Subhas Konar, Dhaval Shukla, Nishanth Sadashiva & Andiperumal Raj Prabhuraj

  2. Lenox Hill Hospital, New York, US

    Souvik Singha

Authors
  1. Subhas Konar
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  2. Souvik Singha
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  3. Dhaval Shukla
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  4. Nishanth Sadashiva
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  5. Andiperumal Raj Prabhuraj
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Contributions

SK—analysis and primary draft, one of the operating surgeons in the unit. SS—data collection. DS—study design, analysis, primary draft, one of the operating surgeons in the unit. NS—one of the operating surgeons in the unit. ARP—one of the operating surgeons in the unit.

Corresponding author

Correspondence to Dhaval Shukla.

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Ethical approval

According to Indian Council of Medical Research (ICMR), 2017, National Guidelines for Biomedical and Health Research Involving Human Participants, Box no. 52 “Consent Waiver” “retrospective studies where participants are deidentified and cannot be contacted” is mentioned. As our study is mere retrospective case record review, Institute Ethics Committee Review was not done.

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Konar, S., Singha, S., Shukla, D. et al. Endoscopic third ventriculostomy (ETV) or ventriculoperitoneal shunt (VPS) for paediatric hydrocephalus due to primary aqueductal stenosis. Childs Nerv Syst 40, 685–693 (2024). https://doi.org/10.1007/s00381-023-06210-w

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