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Long-term outcome for endoscopic third ventriculostomy alone or in combination with choroid plexus cauterization for congenital aqueductal stenosis in African infants.
[hydrocephalus with stenosis of the aqueduct of sylvius]
The
authors
have
previously
reported
on
the
overall
improved
efficacy
of
endoscopic
third
ventriculostomy
(
ETV
)
combined
with
choroid
plexus
cauterization
(
CPC
)
for
infants
younger
than
1
year
of
age
.
In
the
present
study
they
specifically
examined
the
long
-term
efficacy
of
ETV
with
or
without
CPC
in
35
infants
with
congenital
aqueduct
stenosis
treated
at
CURE
Children
's
Hospital
of
Uganda
during
the
years
2001
-
2006
.
Infants
with
congenital
aqueductal
stenosis
were
treated
during
2
distinct
treatment
epochs
:
all
underwent
ETV
alone
,
and
subsequently
all
underwent
ETV-CPC
.
Prospectively
collected
data
in
the
clinical
database
were
reviewed
for
all
infants
with
an
age
<
1
year
who
had
been
treated
for
hydrocephalus
due
to
congenital
aqueductal
stenosis
.
Study
exclusion
criteria
included
:
1
)
a
history
or
findings
on
imaging
or
at
the
time
of
ventriculoscopy
that
suggested
a
possible
infectious
cause
of
the
hydrocephalus
,
including
scarred
choroid
plexus
;
2
)
an
open
aqueduct
or
an
aqueduct
obstructed
by
a
membrane
or
cyst
rather
than
by
stenosis
;
3
)
severe
malformations
of
the
cerebral
hemispheres
including
hydranencephaly
,
significant
segments
of
undeveloped
brain
,
or
schizencephaly
;
4
)
myelomeningocele
,
encephalocele
,
Dandy
-
Walker
complex
,
or
tumor
;
or
5
)
previous
shunt
insertion
.
The
time
to
treatment
failure
was
analyzed
using
the
Kaplan-
Meier
method
to
construct
survival
curves
.
Log-rank
(
Mantel-
Cox
)
and
Gehan-
Breslow-
Wilcoxon
tests
were
used
to
determine
whether
differences
between
the
2
treatment
groups
were
significant
.
Thirty
-
five
patients
met
the
study
criteria
.
Endoscopic
third
ventriculostomy
alone
was
performed
in
12
patients
(
mean
age
4
.
7
months
)
,
and
combined
ETV-CPC
was
performed
in
23
patients
(
mean
age
3
.
5
months
)
.
For
patients
without
treatment
failure
,
the
mean
and
median
follow-ups
were
,
respectively
,
51
.
6
and
48
.
0
months
in
the
ETV
group
and
31
.
2
and
26
.
4
months
in
the
ETV-CPC
group
.
Treatment
was
successful
in
48
.
6
%
of
the
patients
who
underwent
ETV
alone
,
as
accurately
predicted
by
the
Endoscopic
Third
Ventriculostomy
Success
Score
(
ETVSS
)
,
and
in
81
.
9
%
of
the
patients
who
underwent
ETV-CPC
(
p
=
0
.
0119
,
log-rank
test
;
p
=
0
.
0041
,
Gehan-
Breslow-
Wilcoxon
test
;
HR
6
.
42
[
95
%
CI
1
.
51
-
27
.
36
]
)
.
Combined
ETV-CPC
is
significantly
superior
to
ETV
alone
for
infants
younger
than
1
year
of
age
with
congenital
aqueductal
stenosis
.
The
fact
that
the
outcome
for
ETV
alone
was
accurately
predicted
by
the
ETVSS
suggests
that
these
results
are
applicable
in
developed
countries
.
Diseases
Validation
Diseases presenting
"aqueductal stenosis"
symptom
hydrocephalus with stenosis of the aqueduct of sylvius
wiskott-aldrich syndrome
This symptom has already been validated