Understanding Success Rates of Revision Surgery for Failed Endoscopic Third Ventriculostomy and Third Ventriculostomy (ETV-CPC) to Treat Hydrocephalus – New Study Investigates Outcomes and Comparisons with Ventriculoperitoneal shunting (VPS)

What is the success rate of revision endoscopic third ventriculostomy (ETV) after the failure of an initial ETV with choroid plexus cauterization, and does revision ETV compare favorably or outpace outcomes of ventriculoperitoneal shunt after initial surgical failure? 

These are questions answered in a new study published in July 2022 in The Journal of Neurosurgery: Pediatrics by member institutions of the Hydrocephalus Clinical Research Network (HCRN). The study was one of several Editor’s Choice features in the new edition of the journal.

UPMC Children's Hospital of Pittsburgh is a long-standing network member and contributed to the study. Division of Pediatric Neurosurgery chief Ian F. Pollack, MD, FACS, FAAP, FAANS, site PI for HCRN studies at UPMC Children's, contributed to the investigation.

"This analysis was designed to probe deeper into the safety and efficacy of revision ETV and ultimately help clinicians make optimal choices when planning patient care," says Dr. Pollack. "Data on revision surgery outcomes has been limited and variable, and these new findings add valuable clinical insights for the field."

Study Summary and Key Clinical Highlights

This analysis of revision surgery for failed ETV-CPC procedures examined data from 521 cases of initial EVP-CPC procedures to treat hydrocephalus. The study found 91 cases in which a revision ETV procedure was performed due to failure of initial surgery. The study also included 196 cases of VPS after failed ETV-CPC.

The success rate of revision ETV after 1 year was found to be only 29.5%, compared to the 45% success rate when looking at initial ETV-CPC cases at 12 months post-procedure.

Revision surgeries also had a lower success rate than the placement of a ventriculoperitoneal shunt after the failure of an initial ETV-CPC surgery.

Of note, patient age significantly impacted the success rate of revision surgeries, with older patients found to have higher rates of success.

The study did not find any significant relationship between the amount of time between the initial and revision procedure on success rates.

Also of note, for patients with a VPS placed after the initial failed ETV and those with a VPS placed after a revision ETV, there was no observed effect on failure-free survival. Furthermore, there were no significant differences in operative and postsurgical complications or rates of complication between any of the procedures.

“This analysis indicates relatively low success rates for a subsequent ETV if the first one fails, but the decision regarding what procedure to pursue needs to be made on a case-by-case basis in consultation with the patient and family," says Dr. Pollack. "It shows in some respects the superiority of VPS after failure of an initial ETV-CPC and influences how we discuss these various treatment options with families."

Reference

Arynchyna-Smith A, Rozzelle CJ, Jensen H, et al, for the Hydrocephalus Clinical Research Network. Endoscopic Third Ventriculostomy Revision After Failure of Initial Endoscopic Third Ventriculostomy and Choroid Plexus Cauterization. J Neurosurg Pediatr. 2022; 30: 8-17.