Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus.

OBJECTIVE To develop a model to predict the probability of endoscopic third ventriculostomy (ETV) success in the treatment for hydrocephalus on the basis of a child's individual characteristics. STUDY DESIGN We analyzed 618 ETVs performed consecutively on children at 12 international institutions to identify predictors of ETV success at 6 months. A multivariable logistic regression model was developed on 70% of the dataset (training set) and validated on 30% of the dataset (validation set). RESULTS In the training set, 305/455 ETVs (67.0%) were successful. The regression model (containing patient age, cause of hydrocephalus, and previous cerebrospinal fluid shunt) demonstrated good fit (Hosmer-Lemeshow, P = .78) and discrimination (C statistic = 0.70). In the validation set, 105/163 ETVs (64.4%) were successful and the model maintained good fit (Hosmer-Lemeshow, P = .45), discrimination (C statistic = 0.68), and calibration (calibration slope = 0.88). A simplified ETV Success Score was devised that closely approximates the predicted probability of ETV success. CONCLUSIONS Children most likely to succeed with ETV can now be accurately identified and spared the long-term complications of CSF shunting.

[1]  M. Westphal,et al.  Outcome Prediction of Third Ventriculostomy: A Proposed Hydrocephalus Grading System , 2006, Minimally invasive neurosurgery : MIN.

[2]  D. O’Brien,et al.  Is there an indication for ETV in young infants in aetiologies other than isolated aqueduct stenosis? , 2006, Child's Nervous System.

[3]  M. Javadpour,et al.  Sudden death secondary to delayed closure of endoscopic third ventriculostomy , 2003, British journal of neurosurgery.

[4]  M. Javadpour,et al.  The role of neuroendoscopy in the management of tectal gliomas , 2004, Child's Nervous System.

[5]  D. Kleinbaum,et al.  Applied Regression Analysis and Other Multivariate Methods , 1978 .

[6]  S. Ceylan,et al.  Success of endoscopic third ventriculostomy in children less than 2 years of age , 2005, Neurosurgical Review.

[7]  B. Warf.  Comparison of 1-year outcomes for the Chhabra and Codman-Hakim Micro Precision shunt systems in Uganda: a prospective study in 195 children. , 2005, Journal of neurosurgery.

[8]  T. Beems,et al.  Is the success rate of endoscopic third ventriculostomy age-dependent? , 2002, Child's Nervous System.

[9]  J. Drake,et al.  CSF shunts 50 years on – past, present and future , 2000, Child's Nervous System.

[10]  D. O’Brien,et al.  Endoscopic third ventriculostomy: an outcome analysis of primary cases and procedures performed after ventriculoperitoneal shunt malfunction. , 2005, Journal of neurosurgery.

[11]  H. Mehdorn,et al.  Endoscopic third ventriculostomy in infants. , 2005, Journal of neurosurgery.

[12]  A. Brodbelt,et al.  The Impact of Endoscopic Third Ventriculostomy on the Management of Newly Diagnosed Hydrocephalus in Infants , 2001, Pediatric Neurosurgery.

[13]  James R Carpenter,et al.  Recalibration of risk prediction models in a large multicenter cohort of admissions to adult, general critical care units in the United Kingdom* , 2006, Critical care medicine.

[14]  M. Souweidane,et al.  Intraoperative assessment of endoscopic third ventriculostomy success. , 2008, Journal of neurosurgery. Pediatrics.

[15]  B. Rilliet,et al.  Late complications of ventriculoatrial or ventriculoperitoneal shunts , 2001, The Lancet.

[16]  M. McGirt,et al.  Prior CSF shunting increases the risk of endoscopic third ventriculostomy failure in the treatment of obstructive hydrocephalus in adults , 2007, Neurological research.

[17]  L. Massimi,et al.  Shunts vs endoscopic third ventriculostomy in infants: are there different types and/or rates of complications? , 2006, Child's Nervous System.

[18]  J. Drake,et al.  Repeat Cerebrospinal Fluid Shunt Infection in Children , 2001, Pediatric Neurosurgery.

[19]  S. Bratton,et al.  Hospital care for children with hydrocephalus in the United States: utilization, charges, comorbidities, and deaths. , 2008, Journal of neurosurgery. Pediatrics.

[20]  J. Hanley,et al.  The meaning and use of the area under a receiver operating characteristic (ROC) curve. , 1982, Radiology.

[21]  H. Weiner,et al.  Endoscopic third ventriculostomy in patients with cerebrospinal fluid infection and/or hemorrhage. , 2002, Journal of neurosurgery.

[22]  A. Kulkarni,et al.  Quality of life in children with hydrocephalus: results from the Hospital for Sick Children, Toronto. , 2007, Journal of neurosurgery.

[23]  B. Warf,et al.  Hydrocephalus in Uganda: the predominance of infectious origin and primary management with endoscopic third ventriculostomy. , 2005, Journal of neurosurgery.

[24]  S. Sgouros,et al.  Assessment of the influence of operative factors in the success of endoscopic third ventriculostomy in children , 2006, Child's Nervous System.

[25]  O. Idowu,et al.  Initial experience with endoscopic third ventriculostomy in Nigeria, West Africa , 2008, Child's Nervous System.

[26]  S. Constantini,et al.  The international infant hydrocephalus study: concept and rational , 2006, Child's Nervous System.

[27]  J. V. van Gelder,et al.  Long-term Reliability of Endoscopic Third Ventriculostomy , 2005, Neurosurgery.

[28]  P. Katona,et al.  The interaction between nutrition and infection. , 2008, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[29]  J. Drake,et al.  Long-Term Follow-Up Data from the Shunt Design Trial , 2000, Pediatric Neurosurgery.

[30]  C. Sabin,et al.  3-month and 12-month mortality after first liver transplant in adults in Europe: predictive models for outcome , 2006, The Lancet.

[31]  N. Solomons.  MALNUTRITION AND INFECTION: AN UPDATE , 2007, British Journal of Nutrition.

[32]  W. Wagner,et al.  Endoscopic third ventriculostomy in infants of less than 1 year of age: which factors influence the outcome? , 2004, Child's Nervous System.

[33]  J. Stockman.  Reduction in Neural-Tube Defects after Folic Acid Fortification in Canada , 2009 .

[34]  J. Drake.  ENDOSCOPIC THIRD VENTRICULOSTOMY IN PEDIATRIC PATIENTS: THE CANADIAN EXPERIENCE , 2007, Neurosurgery.

[35]  J. Drake,et al.  Cerebrospinal fluid shunt infection: a prospective study of risk factors. , 2001, Journal of neurosurgery.

[36]  S L Hui,et al.  Validation techniques for logistic regression models. , 1991, Statistics in medicine.

[37]  D. O’Brien,et al.  Outcomes in patients undergoing single-trajectory endoscopic third ventriculostomy and endoscopic biopsy for midline tumors presenting with obstructive hydrocephalus. , 2006, Journal of neurosurgery.

[38]  J. Habbema,et al.  Internal validation of predictive models: efficiency of some procedures for logistic regression analysis. , 2001, Journal of clinical epidemiology.

[39]  S J Schiff,et al.  Randomized trial of cerebrospinal fluid shunt valve design in pediatric hydrocephalus. , 1998, Neurosurgery.

[40]  S. Sgouros,et al.  Changes in ventricular volume in hydrocephalic children following successful endoscopic third ventriculostomy , 2004, Child's Nervous System.

[41]  Ewout W Steyerberg,et al.  Internal and external validation of predictive models: a simulation study of bias and precision in small samples. , 2003, Journal of clinical epidemiology.

[42]  L. Wiklund,et al.  Hydrocephalus in children born in 1999–2002: epidemiology, outcome and ophthalmological findings , 2007, Child's Nervous System.