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The effect and evolution of patient selection on outcomes in endoscopic third ventriculostomy for hydrocephalus: A large-scale review of the literature

  • Peter J. Madsen
    Correspondence
    Corresponding author at: Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Silverstein 3rd Floor, Philadelphia, PA 19104, USA
    Affiliations
    Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania Silverstein 3rd Floor, 3400 Spruce Street, Philadelphia, PA 19104, USA
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  • Arka N. Mallela
    Affiliations
    Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania Silverstein 3rd Floor, 3400 Spruce Street, Philadelphia, PA 19104, USA
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  • Eric D. Hudgins
    Affiliations
    Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania Silverstein 3rd Floor, 3400 Spruce Street, Philadelphia, PA 19104, USA
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  • Phillip B. Storm
    Affiliations
    Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania Silverstein 3rd Floor, 3400 Spruce Street, Philadelphia, PA 19104, USA

    Division of Neurosurgery, Children's Hospital of Philadelphia, Wood Building 6th Floor, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
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  • Gregory G. Heuer
    Affiliations
    Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania Silverstein 3rd Floor, 3400 Spruce Street, Philadelphia, PA 19104, USA

    Division of Neurosurgery, Children's Hospital of Philadelphia, Wood Building 6th Floor, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
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  • Sherman C. Stein
    Affiliations
    Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania Silverstein 3rd Floor, 3400 Spruce Street, Philadelphia, PA 19104, USA
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Published:December 20, 2017DOI:https://doi.org/10.1016/j.jns.2017.12.025

      Highlights

      • A large-scale review of ETV for hydrocephalus treatment was performed.
      • Generalizable success rate and complication rate are in line with prior studies.
      • ETV is being performed in more high-risk etiologies over time.
      • Outcomes have remained stable over time despite a trend in changing patient selection.

      Abstract

      Endoscopic third ventriculostomy (ETV) has become a popular technique for the treatment of hydrocephalus, but small sample size has limited the generalizability of prior studies. We performed a large-scale review of all available studies to help eliminate bias and determine how outcomes have changed and been influenced by patient selection over time. A systematic literature search was performed for studies of ETV that contained original, extractable patient data, and a meta-analytic model was generated for correlative and predictive analysis. A total of 130 studies were identified, which included 11,952 cases. Brain tumor or cyst was the most common hydrocephalus etiology, but high-risk etiologies, post-infectious or post-hemorrhagic hydrocephalus, accounted for 18.4%. Post-operative mortality was very low (0.2%) and morbidity was only slightly higher in developing than in industrialized countries. The rate of ETV failure was 34.7% and was higher in the first months and plateaued around 20 months. As anticipated, ETV is less successful in high-risk etiologies of hydrocephalus and younger patients. Younger patient age and high-risk etiologies predicted failure. ETVs were performed more often in high-risk etiologies over time, but, surprisingly, there was no overall change in ETV success rate over time. This study should help to influence optimal patient selection and offer guidance in predicting outcomes.

      Abbreviations:

      ETV (Endoscopic Third Ventriculostomy), CSF (Cerebrospinal Fluid), ETVSS (Endoscopic Third Ventriculostomy Success Score)

      Keywords

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