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Low surgical weight associated with ETV failure in pediatric hydrocephalus patients

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Abstract

The use of endoscopic third ventriculostomy (ETV) for treatment of pediatric hydrocephalus has higher failure rates in younger patients. Here we investigate the impact of select perioperative variables, specifically gestational age, chronological age, birth weight, and surgical weight, on ETV failure rates. A retrospective review was performed on patients treated with ETV - with or without choroid plexus cauterization (CPC) - from 2010 to 2021 at a large academic center. Analyses included Cox regression for independent predictors and Kaplan-Meier survival curves for time to-event outcomes. In total, 47 patients were treated with ETV; of these, 31 received adjunctive CPC. Overall, 66% of the cohort experienced ETV failure with a median failure of 36 days postoperatively. Patients aged < 6 months at time of surgery experienced 80% failure rate, and those > 6 months at time of surgery experienced a 41% failure rate. Univariate Cox regression analysis showed weight at the time of ETV surgery was significantly inversely associated with ETV failure with a hazard ratio of 0.92 (95% CI 0.82, 0.99). Multivariate analysis redemonstrated the inverse association of weight at time of surgery with ETV failure with hazard ratio of 0.76 (95% CI 0.60, 0.92), and sensitivity analysis showed < 4.9 kg as the optimal cutoff predicting ETV/CPC failure. Neither chronologic age nor gestational age were found to be significantly associated with ETV failure.In this study, younger patients experienced higher ETV failure rates, but multivariate regression found that weight was a more robust predictor of ETV failure than chronologic age or gestational age, with an optimal cutoff of 4.9 kg in our small cohort. Given the limited sample size, further study is needed to elucidate the independent role of weight as a peri-operative variable in determining ETV candidacy in young infants. Previous presentations: Poster Presentation, Congress of Neurological Surgeons.

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Please contact corresponding author Ben Succop at benjamin_succop@med.unc.edu to request data and materials used for this manuscript.

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Authors and Affiliations

  1. School of Medicine, University of North Carolina – Chapel Hill, Chapel Hill, NC, USA

    Hannah Black, Benjamin Succop & Andrew Caddell

  2. School of Medicine, Texas A&M, Bryan, TX, USA

    Caren M. Stuebe

  3. Department of Neurosurgery, University of North Carolina – Chapel Hill, Chapel Hill, NC, USA

    Andrea Torres & Carolyn Quinsey

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  1. Hannah Black
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  2. Benjamin Succop
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  4. Andrea Torres
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  6. Carolyn Quinsey
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Contributions

H.B., C.S. wrote the main manuscript text. B.S. and D.C. wrote the results and constructed all figures. C.Q. provided senior faculty guidance and mentorship. All authors reviewed and revised the manuscript.

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Correspondence to Benjamin Succop.

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This project was overseen by the UNC Office of Human Research Ethics (OHRE) institutional review board, IRB 21-1044.

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Black, H., Succop, B., Stuebe, C.M. et al. Low surgical weight associated with ETV failure in pediatric hydrocephalus patients. Neurosurg Rev 47, 176 (2024). https://doi.org/10.1007/s10143-024-02423-y

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