Emergency endoscopic third ventriculostomy for blocked shunts? Univariate and multivariate analysis of independent predictors for failure

Hydrocephalus with a blocked ventriculoperitoneal (VP) shunt is a life-threatening condition. Emergency endoscopic third ventriculostomy (ETV) is a potential treatment option. The aim of the study was to identify independent risk factors associated with failure of ETV in treating patients with block...

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Bibliographic Details
Published in:	Journal of neurosurgery Vol. 131; no. 4; pp. 1004 - 1010
Main Authors:	Chan, David Y C, Tsang, Anderson C O, Ho, Wilson W S, Cheng, Kevin K F, Li, Lai F, Tsang, Frederick C P, Taw, Benedict B T, Pu, Jenny K S, Leung, Gilberto K K, Lui, Matthew W M
Format:	Journal Article
Language:	English
Published:	United States 01-10-2019
Subjects:	endoscopic third ventriculostomy hydrocephalus shunt malfunction ventriculoperitoneal shunt
Online Access:	Get full text
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Summary:	Hydrocephalus with a blocked ventriculoperitoneal (VP) shunt is a life-threatening condition. Emergency endoscopic third ventriculostomy (ETV) is a potential treatment option. The aim of the study was to identify independent risk factors associated with failure of ETV in treating patients with blocked shunts. The authors retrospectively reviewed data from consecutive patients admitted for blocked shunt treated by ETV during the study period from 2000 to 2016. Univariate and multivariate analyses were performed to identify independent factors associated with failed ETV for blocked shunts, such as age, sex, history of CNS infection, number of previous shunt revisions, operations performed as an emergency or elective, number of specialists, and other factors. In total, 121 patients underwent ETV during the study period. Of these, 31 patients (25.6%) had ETV for treatment of a blocked shunt. In 25 (80.6%) of 31 ETV was performed as an emergency procedure. There was no significant difference in the success rate of ETV depending on whether it was performed as an emergency procedure (64% [16/25]) or an elective procedure (66.7% [4/6]; OR 0.062, 95% CI 0.001-2.708; p = 0.149). Univariate and multivariate analyses identified that history of a CNS infection was an independent risk factor for failure of ETV in treating patients with a blocked shunt (OR 0.030, 95% CI 0.001-0.888; p = 0.043). Emergency ETV had a comparable success rate as elective ETV. A history of CNS infection is an independent predictor of ETV failure in treating patients with blocked shunts.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0022-3085 1933-0693 1933-0693
DOI:	10.3171/2018.6.JNS1865