The comparative effectiveness of ventricular shunt placement versus endoscopic third ventriculostomy for initial treatment of hydrocephalus in infants

摘要: Object. The purpose of this study was to compare the effectiveness CSF diversion with endoscopic third ventriculostomy (ETV) versus shunt therapy in infants hydrocephalus. Methods. authors conducted a retrospective analysis 5416 1 year age or younger hydrocephalus (congenital acquired) whom performed using either ETV placement at 41 children’s hospitals between 2004 and 2009. Data were obtained from Pediatric Health Information Systems database. Surgical failure defined as need for repeat operation within initial surgery. compared rates shunt, well patient demographics clinical characteristics, hierarchical regression according treatment group. Results. During period examined, 872 (16.1%) initially underwent 4544 (83.9%) ventricular placement. median infant 37 days (IQR 11–122 days) both More who rather than born prematurely (41.6% vs 23.9%, respectively; p < 0.01) had intraventricular hemorrhage (45.4% 17.5%, 0.01). Higher operative observed opposed surgery (64.5% 39.6%, OR 2.9 [95% CI 2.3–3.5], After controlling prematurity, hemorrhage, spina bifida, remained associated higher risk (OR 2.6 2.1–3.2]). Conclusions. In hydrocephalus, greater 1-year rate may occur after This is most significant procedures first 90 life. Further investigation multiple reoperations, cost, impact surgeon hospital experience necessary distinguish which more effective long term.