Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus: Validation of a success score that predicts long-term outcome - Clinical article

Durnford, Andrew J., Kirkham, Fenella J., Mathad, Nijaguna and Sparrow, Owen C E (2011) Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus: Validation of a success score that predicts long-term outcome - Clinical article. Journal of Neurosurgery: Pediatrics, 8 (5), 489-493. (doi:10.3171/2011.8.PEDS1166).

Abstract

Object. The goal of this study was to externally validate the proposed Endoscopic Third Ventriculostomy Success Score (ETVSS), which predicts successful treatment for hydrocephalus on the basis of a child's individual characteristics. Methods. The authors retrospectively identified 181 cases of consecutive endoscopic third ventriculostomy (ETV) performed in children at a single neurosurgery center in the United Kingdom. They compared actual success at both 6 and 36 months, with mean predicted probabilities for low, moderate, and high chance of success strata based on the ETVSS. Long-term success was calculated using Kaplan-Meier methods and comparisons were made by means of unpaired t-tests. Results. Overall, 166 primary ETVs were performed; ETV success was 72.9% at 6 and 64.5% at 36 months. At long-term follow-up, the mean predicted probability of success was significantly higher in those with a successful ETV (99 patients) than in those with a failed ETV (67 patients) (p = 0.001). The ETVSS accurately predicted outcome at 36 months; the low, medium, and high chance of success strata had mean predicted probabilities of success of 82%, 63%, and 36%, and actual success of 76%, 66%, and 42%, respectively. The overall complication rate was 6%. Conclusions. The ETVSS closely predicted the overall long-term success rates in high-, moderate-, and low-risk groups. The results of this study suggest that the ETVSS will aid clinical decision making in predicting outcome of ETV.

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Contributors

Author: Fenella J. Kirkham

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