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FORUM:Pediatric neurosurgery
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TOPIC: Triventricular HC in children
#485
daniel_nilsson
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Triventricular HC in children 8 Years, 2 Months ago  
There is a controversy on how to treat triventricular HC in young kids.
Is it worth to try an ETV even though we now know that the chance of long-term success in this age group is < 40%? Should we shunt first and then perform an ETV later, for example after 1 year?
- what do you think - shunt or ETV?
 
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#506
Thomas S
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Re:Triventricular HC in children 7 Years, 11 Months ago  
Hi!

The paper by Kulkarni et al in Neurosurgery Aug 2010 addresses this interesting question - they compared the failure rate of endoscopic third ventriculosomty (ETV, n = 489) vs cerebrospinal fluid shunt (n = 720), i.e, totally 1209 children.

They found:
1. ETV has a higher rate of early postoperative failure relative to shunt. This early risk of failure is at least 20% higher than shunt; ie, the early hazard ratio is > 1.2. The authors interprete that this likely reflects the selection of patients for whom ETV was physiologically unsuitable.

2. After about 3 months, the relative risk of failure of ETV is lower than that of shunt and then becomes progressively lower with more time. At 2 years, for example, the risk of ETV failure is roughly half the risk of shunt failure.

The authors conclude that if patients survive the early high-risk period of ETV failure, they could experience long-term treatment survival advantage compared with shunt. It might take several years, however, for this survival advantage to be realized.



Reference:
Kulkarni et al. Endoscopic Third Ventriculostomy Vs Cerebrospinal Fluid Shunt in the Treatment of Hydrocephalus in Children: A Propensity Score–Adjusted Analysis
Neurosurgery 67(3):588-593, 2010.
Click here to read abstract.
 
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#960
griseldarmz
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Re:Triventricular HC in children 2 Years, 11 Months ago  
Pediatric Hydrocephalus: systematic literature review and evidence based guidelines. Part 4 Cerebrospinal fluid shunt or endoscopic third ventriculostomy for the treatment of hydrocephalus in children.
 
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