Clinical and radiologic criteria to predict endoscopic third ventriculostomy success in non-communicating pediatric hydrocephalus.

IF 1.3 4区 医学 Q4 CLINICAL NEUROLOGY
Davit Tatoshvili, Andreas Schaumann, Anna Tietze, Valentina Pennacchietti, Gesa Cohrs, Matthias Schulz, Ulrich-W Thomale
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引用次数: 0

Abstract

Objective: Endoscopic third ventriculocisternostomy (ETV) became the relevant treatment option for non-communicating pediatric hydrocephalus. ETV success was predicted in relation to age, diagnosis, and previous shunt implantation. Radiological factors are usually taken for indication decision-making. The aim of this study is to investigate radiological signs of non-communicating hydrocephalus for ETV success in a single-center retrospective analysis.

Patients and methods: ETV interventions were collected from a 10-year period (2010-2019) from our institution. Clinical patient characteristics such as prematurity, age, diagnosis, and previous shunt treatment and follow-up in terms of possible shunt implantation or revision surgeries were investigated. Radiological data was retrieved from the in-house PACS system to analyze preoperative signs for non-communicating hydrocephalus such as ventricular size, pressure gradients at the third ventricle, and any signs of obstruction from internal towards external cerebral spinal fluid communication. Fisher's test was used to demonstrate the significance of each individual predictor. A multivariable model was built using the backward elimination method with multiple logistic regression.

Results: From 136 ETV interventions, 95 met the inclusion criteria (age < 18 years; > 6-month follow-up; MR image data availability, treatment goal for shunt independence). In chi-square statistical evaluation of single parameters age > 6 months (OR 32.5; 95% CI 4.8-364), ventricular width (FOHR < 0.56; OR 6.1; 95% CI 2.2-16.3) and non-post-hemorrhagic hydrocephalus as underlying diagnosis (OR 13.1; 95% CI 1.9-163) showed significant increased odds ratio for shunt independence during follow-up. Logistic regression analysis for multiple parameters showed age > 6 months (OR 29.3; 95% CI 4.1-606) together with outward bulged lamina terminalis (OR 4.6; 95% CI 1.2-19.6), smaller FOHR (continuous parameter; OR 2.83 × 10-5; 95% CI 4.7 × 10-9-0.045), and non-4th-ventricular-outlet obstruction (4thVOO; OR 0.31; 95% CI 0.09-1.02) as significant factors for ETV success.

Conclusion: ETV has become a relevant treatment for non-communicating hydrocephalus, with typical MR image characteristics. Analyzing radiological markers as predictors for success smaller ventricular width and outward displaced lamina terminalis was relevant in combination with age > 6 months. Since the analysis is based on single-center experience, a larger cohort of patients with a multi-center approach should further investigate the combined clinical and radiological criteria.

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来源期刊
Child's Nervous System
Child's Nervous System 医学-临床神经学
CiteScore
3.00
自引率
7.10%
发文量
322
审稿时长
3 months
期刊介绍: The journal has been expanded to encompass all aspects of pediatric neurosciences concerning the developmental and acquired abnormalities of the nervous system and its coverings, functional disorders, epilepsy, spasticity, basic and clinical neuro-oncology, rehabilitation and trauma. Global pediatric neurosurgery is an additional field of interest that will be considered for publication in the journal.
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