Rate of Head Circumference Growth as a Predictor of Shunt Dependency in Posthemorrhagic Hydrocephalus of Prematurity

Maryam N. Shahin; Ahmed Helal; Mrinal Thapliyal; Laken Behrndt; Brannan E. O'Neill; Christian G. L. Ramos; Yasmeen N. Elsawaf; Christina M. Sayama; Lissa Baird; Jesse L. Winer

doi:10.1055/a-2672-2979

Neuropediatrics, Table of Contents

Neuropediatrics
DOI: 10.1055/a-2672-2979

Original Article

Rate of Head Circumference Growth as a Predictor of Shunt Dependency in Posthemorrhagic Hydrocephalus of Prematurity

Maryam N. Shahin

¹Department of Neurological Surgery, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon, United States

,

Ahmed Helal

¹Department of Neurological Surgery, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon, United States

,

Mrinal Thapliyal

¹Department of Neurological Surgery, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon, United States

,

Laken Behrndt

¹Department of Neurological Surgery, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon, United States

,

Brannan E. O'Neill

¹Department of Neurological Surgery, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon, United States

,

Christian G. L. Ramos

¹Department of Neurological Surgery, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon, United States

,

Yasmeen N. Elsawaf

¹Department of Neurological Surgery, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon, United States

,

Christina M. Sayama

¹Department of Neurological Surgery, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon, United States

,

Lissa Baird

¹Department of Neurological Surgery, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon, United States

,

Jesse L. Winer

¹Department of Neurological Surgery, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon, United States

› Author Affiliations

Abstract

Objectives

The timing and indications for endoscopic third ventriculostomy (ETV) in pediatric hydrocephalus are debated. We evaluated head circumference growth as a predictor of ETV success in children with posthemorrhagic hydrocephalus (PHH).

Methods

We conducted a retrospective review of 303 patients who underwent ETV from 2012 to 2021, focusing on those with intraventricular hemorrhage (IVH) and PHH. Data were collected from electronic medical records. A univariate logistic regression analyzed predictors of ETV failure, with head circumference growth rate calculated from preoperative occipito-frontal circumference measurements.

Results

Among the 303 patients, 24 had IVH and PHH. Mean gestational age was 30 weeks, with 58% male, and a mean weight of 4.48 kg at surgery. Notably, 96% (n = 23) had choroid plexus cauterization, and 46% (n = 11) underwent ventriculosubgaleal shunt. Of the 24, 67% (n = 16) required eventual ventriculoperitoneal shunt (VPS) placement, indicating ETV failure. Corrected age at ETV was younger in the failure group (0.69 months) than in the success group (2.56 months, p = 0.020, odds ratio [OR]: 1.04). Mean weight at surgery was lower for the failure group (3.85 kg vs. 5.75 kg, p = 0.036). Duration of preoperative surveillance was 1.94 months for the failure group and 5.25 months for the success group (p = 0.004). Head circumference growth rate was 1.57 mm/day in the failure group compared to 0.85 mm/day in the success group (p = 0.009, OR: 39.9).

Conclusion

Younger corrected age, lower weight at surgery, shorter preoperative surveillance time, and faster head circumference growth rate were associated with ETV failure and ultimately VPS placement. Further analysis with a larger cohort may enhance predictions of ETV success rates.

Keywords

hydrocephalus - endoscopic third ventriculostomy - intraventricular hemorrhage - ventriculoperitoneal shunt - head circumference

Full Text

References

References
1 Kulkarni AV, Riva-Cambrin J, Browd SR. Use of the ETV Success Score to explain the variation in reported endoscopic third ventriculostomy success rates among published case series of childhood hydrocephalus. J Neurosurg Pediatr 2011; 7 (02) 143-146
2 Usami K, Ishisaka E, Ogiwara H. Endoscopic third ventriculostomy and cerebrospinal fluid shunting for pure communicating hydrocephalus in children. Childs Nerv Syst 2021; 37 (09) 2813-2819
3 Kulkarni AV, Riva-Cambrin J, Holubkov R. et al; Hydrocephalus Clinical Research Network. Endoscopic third ventriculostomy in children: prospective, multicenter results from the Hydrocephalus Clinical Research Network. J Neurosurg Pediatr 2016; 18 (04) 423-429
4 Durnford AJ, Kirkham FJ, Mathad N, Sparrow OC. Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus: validation of a success score that predicts long-term outcome. J Neurosurg Pediatr 2011; 8 (05) 489-493
5 Hong S, Hirokawa D, Usami K, Ogiwara H. The long-term outcomes of endoscopic third ventriculostomy in pediatric hydrocephalus, with an emphasis on future intellectual development and shunt dependency. J Neurosurg Pediatr 2019; 23 (01) 104-108
6 Weil AG, Fallah A, Chamiraju P, Ragheb J, Bhatia S. Endoscopic third ventriculostomy and choroid plexus cauterization with a rigid neuroendoscope in infants with hydrocephalus. J Neurosurg Pediatr 2016; 17 (02) 163-173
7 Kulkarni AV, Riva-Cambrin J, Browd SR. et al; Hydrocephalus Clinical Research Network. Endoscopic third ventriculostomy and choroid plexus cauterization in infants with hydrocephalus: a retrospective Hydrocephalus Clinical Research Network study. J Neurosurg Pediatr 2014; 14 (03) 224-229
8 Stone SS, Warf BC. Combined endoscopic third ventriculostomy and choroid plexus cauterization as primary treatment for infant hydrocephalus: a prospective North American series. J Neurosurg Pediatr 2014; 14 (05) 439-446
9 Kulkarni AV, Riva-Cambrin J, Rozzelle CJ. et al. Endoscopic third ventriculostomy and choroid plexus cauterization in infant hydrocephalus: a prospective study by the Hydrocephalus Clinical Research Network. J Neurosurg Pediatr 2018; 21 (03) 214-223
10 Pan IW, Harris DA, Luerssen TG, Lam SK. Comparative effectiveness of surgical treatments for pediatric hydrocephalus. Neurosurgery 2018; 83 (03) 480-487
11 Kulkarni AV, Sgouros S, Constantini S. IIHS Investigators. International Infant Hydrocephalus Study: initial results of a prospective, multicenter comparison of endoscopic third ventriculostomy (ETV) and shunt for infant hydrocephalus. Childs Nerv Syst 2016; 32 (06) 1039-1048
12 Gianaris TJ, Nazar R, Middlebrook E, Gonda DD, Jea A, Fulkerson DH. Failure of ETV in patients with the highest ETV success scores. J Neurosurg Pediatr 2017; 20 (03) 225-231
13 Shah AH, Ibrahim GM, Sasaki J, Ragheb J, Bhatia S, Niazi TN. Multiple echocardiography abnormalities associated with endoscopic third ventriculostomy failure. J Neurosurg Pediatr 2018; 21 (01) 25-30
14 Tsuda K, Ihara S. Transependymal edema as a predictor of endoscopic third ventriculostomy success in pediatric hydrocephalus. World Neurosurg 2021; 156: e215-e221
15 Rocque BG, Jensen H, Reeder RW. et al; Hydrocephalus Clinical Research Network. Endoscopic third ventriculostomy in previously shunt-treated patients. J Neurosurg Pediatr 2022; 30 (04) 428-436
16 Wang Q, Cheng J, Zhang S, Li Q, Hui X, Ju Y. Prediction of endoscopic third ventriculostomy (ETV) success with preoperative third ventricle floor bowing (TVFB): a supplement to ETV success score. Neurosurg Rev 2020; 43 (06) 1575-1581
17 Lee KS, Chari A, Gillespie CS. et al. Endoscopic third ventriculostomy for shunt malfunction in the pediatric population: a systematic review, meta-analysis, and meta-regression analysis. J Neurosurg Pediatr 2023; 31 (05) 423-432
18 Coulter IC, Kulkarni AV, Sgouros S. et al; International Infant Hydrocephalus Study Investigators. Cranial and ventricular size following shunting or endoscopic third ventriculostomy (ETV) in infants with aqueductal stenosis: further insights from the International Infant Hydrocephalus Study (IIHS). Childs Nerv Syst 2020; 36 (07) 1407-1414
19 Dewan MC, Lim J, Gannon SR. et al. Comparison of hydrocephalus metrics between infants successfully treated with endoscopic third ventriculostomy with choroid plexus cauterization and those treated with a ventriculoperitoneal shunt: a multicenter matched-cohort analysis. J Neurosurg Pediatr 2018; 21 (04) 339-345
20 Dewan MC, Lim J, Morgan CD. et al. Endoscopic third ventriculostomy with choroid plexus cauterization outcome: distinguishing success from failure. J Neurosurg Pediatr 2016; 25 (06) 655-662
21 Singh R, Prasad RS, Singh RC, Trivedi A, Bhaikhel KS, Sahu A. Evaluation of pediatric hydrocephalus: clinical, surgical, and outcome perspective in a tertiary center. Asian J Neurosurg 2021; 16 (04) 706-713
22 Shankaran S, Koepke T, Woldt E. et al. Outcome after posthemorrhagic ventriculomegaly in comparison with mild hemorrhage without ventriculomegaly. J Pediatr 1989; 114 (01) 109-114
23 Radic JAE, Vincer M, McNeely PD. Outcomes of intraventricular hemorrhage and posthemorrhagic hydrocephalus in a population-based cohort of very preterm infants born to residents of Nova Scotia from 1993 to 2010. J Neurosurg Pediatr 2015; 15 (06) 580-588
24 Cizmeci MN, Khalili N, Claessens NHP. et al; ELVIS study group. Assessment of brain injury and brain volumes after posthemorrhagic ventricular dilatation: a nested substudy of the randomized controlled ELVIS trial. J Pediatr 2019; 208: 191-197.e2
25 Paturu M, Triplett RL, Thukral S. et al. Does ventricle size contribute to cognitive outcomes in posthemorrhagic hydrocephalus? Role of early definitive intervention. J Neurosurg Pediatr 2021; 29 (01) 10-20