Original ArticleThe Impact of Endoscopic Third Ventriculostomy on Shunt Revision Rate: A 14-Year Experience at a Single Institution
Introduction
Shunt-related procedures in the treatment of hydrocephalus have historically accounted for nearly 50% of pediatric neurosurgical procedures (7). Shunt malfunctions and revisions result in significant morbidity for patients as well as financial impact on the health care system 1, 11. The increased utilization of endoscopic third ventriculostomy (ETV) as an alternative treatment paradigm for obstructive hydrocephalus carries the theoretical expectation of a concomitant decrease in shunt-related procedures. During the past 2 decades, shunt-free success rates for certain forms of hydrocephalus have increased from 50% to >80% 4, 9, 12, 13, 15. ETV has therefore emerged as the preferred treatment for noncommunicating hydrocephalus in select patients 16, 17, 19. However, the impact of ETV on the overall case distribution, as it relates to shunt-related procedures, has not yet been formally and specifically evaluated.
In an effort to better understand the impact of increasing ETV utilization on shunt-related procedures, we determined the annual rate of each procedure during a 14-year period (1998–2011), during which ETV has gained wider acceptance and greater utilization. All procedures for ETV, shunt insertion, and shunt revision were included. Although not directly calculated, these findings suggest an important decrease in the economic burden of shunt-related procedures and on-the-call burden of the pediatric neurosurgical workforce.
Section snippets
Methods
During a 14-year interval from 1998 to 2011, pediatric patients who underwent either ETV or shunt-related procedures at New York Presbyterian Hospital Weill-Cornell Medical Center were included in a retrospective chart review.
The review was limited to patients between 0 and 18 years of age who had undergone ETV, ETV revision, ventriculoperitoneal shunt, ventriculopleural shunt, ventriculoatrial shunt insertion, shunt removal, and shunt revision. All surgeries in this patient cohort were
Results
During the 14-year study period, 954 procedures were performed for the treatment of hydrocephalus. Of these, there were 159 ETVs and 795 shunt-related procedures. Of the shunts, 356 were initial insertions and 439 were revisions. The number of ETVs increased over time from 8 procedures in 1998/1999, when it was first introduced at this institution by M.M.S., to 34 in 2010/2011 (Table 1). Concomitantly, the total number of annual shunt-related procedures decreased from 146 to 99 during the same
Discussion
Shunt-related procedures in the treatment of hydrocephalus comprise a large percentage of cases performed by pediatric neurosurgeons (7). The susceptibility of shunts to malfunction and necessary revision contributes to significant morbidity for the patient. The use of ETV has, therefore, emerged as a safe and effective alternative to shunt placement and revision in specific patient populations 2, 5, 6. In an effort to better understand the evolution of ETV and its impact on shunt-related
Conclusions
Although other factors in addition to increased utilization of ETV may affect our case numbers, a clear shift toward higher relative rates of ETV versus shunt revisions is demonstrated. Based on prior cost-effectiveness analyses, the decrease in cumulative rate of shunt-related procedures is likely to contribute to cost savings and improvement in patient outcomes. Further study is required to define the impact on patient morbidity of the relative rates and associated success rates and long-term
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Cited by (4)
Role of endoscopic third ventriculostomy in patients undergoing resection of pulvinar area lesions: Preliminary clinical results
2023, Journal of Clinical NeuroscienceEndoscopic Third Ventriculostomy in Cases of Ventriculoperitoneal Shunt Malfunction: Does Shunt Duration Play a Role?
2019, World NeurosurgeryCitation Excerpt :Shunt failure during a patient's life is a common event.1,2 Endoscopic third ventriculostomy (ETV) is theoretically less invasive than shunt revision and has progressively gained a consensus for managing ventriculoperitoneal shunt (VPS) malfunctions.1,3-6 ETV performed after a VPS failure is commonly termed secondary ETV.1,2,5,7,8
Myelomeningocele-associated hydrocephalus: Nationwide analysis and systematic review
2019, Neurosurgical Focus
Supplementary digital content available online.
Conflict of interest statement: Mark M. Souweidane serves as a paid consultant and member of the NeuroEndoscopy Advisory Board for Aesculap. The other authors have no known conflicts of interest or significant financial support associated with this publication to declare.