Erschienen in:
21.01.2020 | Original Article
Cranial and ventricular size following shunting or endoscopic third ventriculostomy (ETV) in infants with aqueductal stenosis: further insights from the International Infant Hydrocephalus Study (IIHS)
verfasst von:
Ian C. Coulter, Abhaya V. Kulkarni, Spyros Sgouros, Shlomi Constantini, Shlomi Constantini, Spyros Sgouros, Abhaya V. Kulkarni, Yael Leitner, John RW Kestle, Douglas D Cochrane, Maurice Choux, Fleming Gjerris, Adina Sherer, Nejat Akalan, Burçak Bilginer, Ramon Navarro, Ljiljana Vujotic, Hannes Haberl, Ulrich-Wilhelm Thomale, Graciela Zúccaro, Roberto Jaimovitch, David Frim, Lori Loftis, Dale M. Swift, Brian Robertson, Lynn Gargan, László Bognár, László Novák, Georgina Cseke, Armando Cama, Giuseppe Marcello Ravegnani, Matthias Preuß, Henry W. Schroeder, Michael Fritsch, Joerg Baldauf, Marek Mandera, Jerzy Luszawski, Patrycja Skorupka, Conor Mallucci, Dawn Williams, Krzysztof Zakrzewski, Emilia Nowoslawska, Chhitij Srivastava, Ashok K. Mahapatra, Raj Kumar, Rabi Narayan Sahu, Armen G. Melikian, Anton Korshunov, Anna Galstyan, Ashish Suri, Deepak Gupta, J. André Grotenhuis, Erik J. van Lindert, José Aloysio da Costa Val, Concezio Di Rocco, Gianpiero Tamburrini, Samuel Tau Zymberg, Sergio Cavalheiro, Ma Jie, Jiang Feng, Orna Friedman, Naheeda Rajmohamed, Marcin Roszkowski, Slawomir Barszcz, George Jallo, David W. Pincus, Bridget Richter, HM Mehdorn, Susan Schultka, Sandrine de Ribaupierre, Dominic Thompson, Silvia Gatscher, Wolfgang Wagner, Dorothee Koch, Saverio Cipri, Claudio Zaccone, Patrick McDonald, for the International Infant Hydrocephalus Study Investigators
Erschienen in:
Child's Nervous System
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Ausgabe 7/2020
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Abstract
Purpose
The craniometrics of head circumference (HC) and ventricular size are part of the clinical assessment of infants with hydrocephalus and are often utilized in conjunction with other clinical and radiological parameters to determine the success of treatment. We aimed to assess the effect of endoscopic third ventriculostomy (ETV) and shunting on craniometric measurements during the follow-up of a cohort of infants with symptomatic triventricular hydrocephalus secondary to aqueductal stenosis.
Methods
We performed a post hoc analysis of data from the International Infant Hydrocephalus Study (IIHS)—a prospective, multicenter study of infants (< 24 months old) with hydrocephalus from aqueductal stenosis who were treated with either an ETV or shunt. During various stages of a 5-year follow-up period, the following craniometrics were measured: HC, HC centile, HC z-score, and frontal-occipital horn ratio (FOR). Data were compared in an analysis of covariance, adjusting for baseline variables including age at surgery and sex.
Results
Of 158 enrolled patients, 115 underwent an ETV, while 43 received a shunt. Both procedures led to improvements in the mean HC centile position and z-score, a trend which continued until the 5-year assessment point. A similar trend was noted for FOR which was measured at 12 months and 3 years following initial treatment. Although the values were consistently higher for ETV compared with shunt, the differences in HC value, centile, and z-score were not significant. ETV was associated with a significantly higher FOR compared with shunting at 12 months (0.52 vs 0.44; p = 0.002) and 3 years (0.46 vs 0.38; p = 0.03) of follow-up.
Conclusion
ETV and shunting led to improvements in HC centile, z-score, and FOR measurements during long-term follow-up of infants with hydrocephalus secondary to aqueductal stenosis. Head size did not significantly differ between the treatment groups during follow-up, however ventricle size was greater in those undergoing ETV when measured at 1 and 3 years following treatment.