Predictors of endoscopic third ventriculostomy ostomy status in patients who experience failure of endoscopic third ventriculostomy with choroid plexus cauterization.

Authors:
Andrew T Hale
Andrew T Hale
From the Case Cardiovascular Research Institute and Harrington Heart & Vascular Institute and
Amanda N Stanton
Amanda N Stanton
University of Virginia
Shilin Zhao
Shilin Zhao
Center for Quantitative Sciences
Faizal Haji
Faizal Haji
University of Western Ontario
Canada
Stephen R Gannon
Stephen R Gannon
Vanderbilt University
Anastasia Arynchyna
Anastasia Arynchyna
Section of Pediatric Neurosurgery; and
John C Wellons
John C Wellons
Children's Hospital
United States
Brandon G Rocque
Brandon G Rocque
University of Wisconsin

J Neurosurg Pediatr 2019 Apr 19:1-6. Epub 2019 Apr 19.

1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville.

OBJECTIVEAt failure of endoscopic third ventriculostomy (ETV) with choroid plexus cauterization (CPC), the ETV ostomy may be found to be closed or open. Failure with a closed ostomy may indicate a population that could benefit from evolving techniques to keep the ostomy open and may be candidates for repeat ETV, whereas failure with an open ostomy may be due to persistently abnormal CSF dynamics. This study seeks to identify clinical and radiographic predictors of ostomy status at the time of ETV/CPC failure.METHODSThe authors conducted a multicenter, retrospective cohort study on all pediatric patients with hydrocephalus who failed initial ETV/CPC treatment between January 2013 and October 2016. Failure was defined as the need for repeat ETV or ventriculoperitoneal (VP) shunt placement. Clinical and radiographic data were collected, and ETV ostomy status was determined endoscopically at the subsequent hydrocephalus procedure. Statistical analysis included the Mann-Whitney U-test, Wilcoxon rank-sum test, t-test, and Pearson chi-square test where appropriate, as well as multivariate logistic regression.RESULTSOf 72 ETV/CPC failures, 28 patients (39%) had open-ostomy failure and 44 (61%) had closed-ostomy failure. Patients with open-ostomy failure were older (median 5.1 weeks corrected age for gestation [interquartile range (IQR) 0.9-15.9 weeks]) than patients with closed-ostomy failure (median 0.2 weeks [IQR -1.3 to 4.5 weeks]), a significant difference by univariate and multivariate regression. Etiologies of hydrocephalus included intraventricular hemorrhage of prematurity (32%), myelomeningocele (29%), congenital communicating (11%), aqueductal stenosis (11%), cyst/tumor (4%), and other causes (12%). A wider baseline third ventricle was associated with open-ostomy failure (median 15.0 mm [IQR 10.3-18.5 mm]) compared to closed-ostomy failure (median 11.7 mm [IQR 8.9-16.5 mm], p = 0.048). Finally, at the time of failure, patients with closed-ostomy failure had enlargement of their ventricles (frontal and occipital horn ratio [FOHR], failure vs baseline, median 0.06 [IQR 0.00-0.11]), while patients with open-ostomy failure had no change in ventricle size (median 0.01 [IQR -0.04 to 0.05], p = 0.018). Previous CSF temporizing procedures, intraoperative bleeding, and time to failure were not associated with ostomy status at ETV/CPC failure.CONCLUSIONSOlder corrected age for gestation, larger baseline third ventricle width, and no change in FOHR were associated with open-ostomy ETV/CPC failure. Future studies are warranted to further define and confirm features that may be predictive of ostomy status at the time of ETV/CPC failure.

Download full-text PDF

Source
https://thejns.org/view/journals/j-neurosurg-pediatr/aop/art
Publisher Site
http://dx.doi.org/10.3171/2019.2.PEDS18743DOI Listing
April 2019
8 Reads

Publication Analysis

Top Keywords

ostomy status
20
failure
18
closed-ostomy failure
16
open-ostomy failure
16
third ventriculostomy
12
endoscopic third
12
failure median
12
ostomy
9
patients closed-ostomy
8
etv ostomy
8
age gestation
8
median weeks
8
failure patients
8
patients open-ostomy
8
time failure
8
time etv/cpc
8
third ventricle
8
baseline third
8
status time
8
associated open-ostomy
8

References

(Supplied by CrossRef)
Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus
KulkarniAV et al.
J Pediatr 2009
Comparison of endoscopic third ventriculostomy alone and combined with choroid plexus cauterization in infants younger than 1 year of age: a prospective study in 550 African children
Warf et al.
J Neurosurg 2005

Similar Publications