Journal article
Preoperative third ventricular bowing as a predictor of endoscopic third ventriculostomy success: Clinical article
Journal of neurosurgery. Pediatrics, Vol.9(2), pp.182-190
02/2012
DOI: 10.3171/2011.11.PEDS11495
PMID: 22295925
Abstract
Object Patients with hydrocephalus often present with both intraventricular obstructive and communicating components, and determination of the predominant component is difficult. Other investigators have observed that third ventricular floor deformation, or “bowing” of the third ventricular floor, is a good indicator of intraventricular obstructive hydrocephalus, resulting in higher success rates with endoscopic third ventriculostomy (ETV). However, additional third ventricular bowing assessment and statistical evidence demonstrating a difference in ETV outcome with third ventricular bowing is needed. The authors hypothesized that patients with preoperative bowing of the third ventricle would exhibit greater long-term success rates after ETV and that lack of bowing would result in increased failure rates after ETV. Methods The authors determined success and failure for 59 ETVs performed in 56 patients, and recorded patient age, time to failure, and preoperative third ventricular anatomy, as well as history of infection, intraventricular hemorrhage, and previous shunt. Third ventricular anatomy was assessed on MR imaging for bowing, which was classified as any of the following: depression of the third ventricular floor, enlargement of the supraoptic recess, anterior curvature of the lamina terminalis, dilation of the proximal aqueduct to a greater extent than the distal aqueduct, and blunting or posterior bowing of the suprapineal recess. Univariate and multivariate analyses of ETV failure and the time to failure were performed using logistic regression and the Cox proportional hazards model, respectively. Results After adjusting for patient age and history of infection, there was a significant association between lack of anterior third ventricular preoperative bowing (either lamina terminalis, supraoptic recess, or third ventricular floor) and ETV failure (adjusted HR 2.79, 95% CI 1.08–7.20). Of the patients with bowing, 70.5% experienced success with ETV, as did 33.3% of the patients without bowing. Among the individual structures, absence of bowing in the anterior aspect of the third ventricular floor was significantly associated with censored time to ETV failure (multivariate HR 2.59, 95% CI 1.01–6.66; final model including age and history of infection). Conclusions The presence of preoperative third ventricular bowing is predictive of ETV success, with nearly a 3-fold likelihood of success compared with patients treated with ETV in the absence of such bowing. Although bowing is predictive, 33% of patients without bowing were also treated successfully with ETV.
Details
- Title: Subtitle
- Preoperative third ventricular bowing as a predictor of endoscopic third ventriculostomy success: Clinical article
- Creators
- Brian J Dlouhy - 1Department of Neurosurgery, andAna W Capuano - 2College of Public Health, University of Iowa Hospitals and Clinics, Iowa City, IowaKarthik Madhavan - 1Department of Neurosurgery, andJames C Torner - 2College of Public Health, University of Iowa Hospitals and Clinics, Iowa City, IowaJeremy D. W Greenlee - 1Department of Neurosurgery, and
- Resource Type
- Journal article
- Publication Details
- Journal of neurosurgery. Pediatrics, Vol.9(2), pp.182-190
- DOI
- 10.3171/2011.11.PEDS11495
- PMID
- 22295925
- NLM abbreviation
- J Neurosurg Pediatr
- ISSN
- 1933-0707
- eISSN
- 1933-0715
- Language
- English
- Date published
- 02/2012
- Academic Unit
- Stead Family Department of Pediatrics; Epidemiology; Iowa Neuroscience Institute; Surgery; Injury Prevention Research Center; Neurosurgery; Otolaryngology
- Record Identifier
- 9983996059202771
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