Subscribe to RSS
DOI: 10.1055/s-0042-1742707
Endoscopic Third Ventriculostomy in the Pediatric Population: Case Series Report[*]
Terceiro ventriculostomia endoscópica na população pediátrica: Relato de série de casos
Abstract
Objective Hydrocephalus is characterized by multi- or uniloculated ventricular dilatation, and there are differences between the etiology and therapeutic response of each type. Endoscopic third ventriculostomy (ETV) is indicated for the treatment of obstructive hydrocephalus, with a reported efficacy between 50% and 76%. Reduced efficacy of the procedure has been demonstrated in communicating hydrocephalus due to multifactorial pathogenesis, and, in patients with myelomeningocele, its efficacy ranges from 15% to 20% at birth. The present study aims to compare the efficacy of ETV in the treatment of congenital obstructive hydrocephalus (COH) and acquired obstructive hydrocephalus (AOH) in the pediatric population.
Methods A retrospective study of 169 endoscopic surgeries performed by the senior author in two institutions, one public (Hospital João XXIII, Belo Horizonte, Minas Gerais) and another private (Hospital Felício Rocho, Belo Horizonte, Minas Gerais), in the period from 2003 a 2020. From the selection of 169 patients, only 77 cases fit the age profile ≤12 years of the present study. Of these, 46 were male, and the age range ranged from 10 days to 12 years. The study included multiple etiologies, which were divided into 2 groups, 34 related to COH, and 43 to AOH.
Results Regarding the cases of COH, 22 were submitted to ETV as the main treatment, with 14 (63.63%) effective and 8 (36.36%) ineffective procedures. As for the cases of AOH, 13 patients underwent ETV, and 8 (61.53%) procedures were effective, and 5 (38.46%), ineffective.
Conclusions Through the calculation of the p-value of 0.49, we concluded that it cannot stated that the efficacy of ETV is greater in COH than in AOH.
Resumo
Objetivo A hidrocefalia é caracterizada por dilatação ventricular multi ou uniloculada, e há diferenças entre a etiologia e a resposta terapêutica de cada tipo. A terceiro ventriculostomia endoscópica (TVE) está indicada no tratamento da hidrocefalia obstrutiva, com uma eficácia relatada entre 50% e 76%. O procedimento demonstrou eficácia reduzida em hidrocefalia comunicante devido à patogênese multifatorial, sendo que, em pacientes com mielomeningocele, sua eficácia é de 15% a 20% no nascimento. Este estudo visa comparar a eficácia da TVE no tratamento da hidrocefalia obstrutiva congênita (HOC) e hidrocefalia obstrutiva adquirida (HOA) na população pediátrica.
Métodos Realizou-se um estudo retrospectivo de 169 cirurgias endoscópicas realizadas pelo autor sênior em duas instituições, uma pública (Hospital João XXIII, Belo Horizonte, Minas Gerais) e outra privada (Hospital Felício Rocho, Belo Horizonte, Minas Gerais), no período de 2003 a 2020. Da seleção de 169 pacientes, apenas 77 casos se enquadraram no perfil de idade ≤12 anos do presente estudo. Destes, 46 eram do sexo masculino, e a faixa etária variou de 10 dias a 12 anos. O estudo contemplou múltiplas etiologias, que foram divididas em 2 grupos, sendo 34 relacionadas à HOC, e 43, à HOA.
Resultados Entre os casos de HOC, 22 foram submetidos a TVE como tratamento principal, sendo que 14 (63,63%) procedimentos foram eficazes, e 8 (36,36%), ineficazes. Já entre os casos de HOA,13 pacientes foram submetidos a TVE, sendo 8 (61,53%) procedimentos eficazes, e 5 (38,46%), ineficazes.
Conclusões Por meio do cálculo do valor de p de 0,49, concluiu-se que não se pode afirmar que a eficácia da TVE é maior nas HOCs do que nas HOAs
* Work performed at Hospital João XXIII and Hospital Felício Rocho, Belo Horizonte, Minas Gerais, Brazil.
Publication History
Received: 02 November 2021
Accepted: 20 December 2021
Article published online:
05 September 2022
© 2022. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil
-
References
- 1 Peraio S, Amen MM, Ali NM, Zaher A, Mohamed Taha AN, Tamburrini G. Endoscopic Management of Pediatric Complex Hydrocephalus. World Neurosurg 2018; 119: e482-e490 DOI: 10.1016/j.wneu.2018.07.187. [Internet]
- 2 Feng Z, Li Q, Gu J, Shen W. Update on endoscopic third ventriculostomy in children. Pediatr Neurosurg 2018; 53 (06) 367-370
- 3 Deopujari CE, Karmarkar VS, Shaikh ST. Endoscopic third ventriculostomy: Success and failure. J Korean Neurosurg Soc 2017; 60 (03) 306-314
- 4 Kulkarni AV, Sgouros S, Leitner Y, Constantini S. International Infant Hydrocephalus Study Investigators. International Infant Hydrocephalus Study (IIHS): 5-year health outcome results of a prospective, multicenter comparison of endoscopic third ventriculostomy (ETV) and shunt for infant hydrocephalus. Childs Nerv Syst 2018; 34 (12) 2391-2397
- 5 Baldauf J, Oertel J, Gaab MR, Schroeder HW. Endoscopic third ventriculostomy in children younger than 2 years of age. Childs Nerv Syst 2007; 23: 623-626
- 6 Sufianov AA, Sufianova GZ, Iakimov IA. Endoscopic third ventriculostomy in patients younger than 2 years: outcome analysis of 41 hydrocephalus cases. J Neurosurg Pediatr 2010; 5: 392-401