Predicting success of endoscopic third ventriculostomy: validation of the ETV Success Score in a mixed population of adult and pediatric patients

• DOI: 10.3171/2014.12.jns141240
• Publication Date: 2015-07-24T13:59:16Z
• Authors: Moujahed Labidi; Pascale Lavoie; Geneviève Lapointe; Sami Obaid; Alexander G. Weil; Michel W. Bojanowski; André Turmel
• Keywords: Endoscopic third ventriculostomy

Endoscopic third ventriculostomy (ETV) has become the first line of treatment in obstructive hydrocephalus. The Toronto group (Kulkarni et al.) developed ETV Success Score (ETVSS) to predict clinical response following based on age, previous shunt, and cause hydrocephalus a pediatric population. However, use ETVSS not been validated for population comprising adults. objective this study was validate "closed-skull" population, including patients 2 years age older.In retrospective observational study, medical charts all consecutive cases performed two university hospitals were reviewed. primary outcome, success ETV, defined as absence reoperation or death attributable at 6 months. calculated patients. Discriminative properties along with calibration established secondary outcome is reoperation-free survival.This included 168 ETVs. mean 40 (range 3-85 years). successful months 126 (75%) compared 82.4%. area under receiver operating characteristic curve 0.61, revealing insufficient discrimination from In contrast, excellent (calibration slope = 1.01), although expected low numbers obtained scores < 70. Decision analyses demonstrate that marginally beneficial decision-making, reduction 4 avoidable ETVs per 100 if threshold used set 70 60, respectively. showed inferior net benefit when strategy recommending surgical option thresholds 80 90. cohort, neither nor shunt significantly associated unsuccessful ETV. better outcomes achieved aqueductal stenosis, tectal compressions, other tumor-associated than myelomeningocele, infection, hemorrhage (p 0.03).The did show adequate but demonstrated older. According decision-curve analyses, useful scenarios which 60% 70% rates are preferring CSF shunt. Previous history worse outcomes, whereas posthemorrhagic postinfectious causes reduced