Abstract | OBJECT: METHODS: One hundred fifteen consecutive East African infants with myelomeningocele requiring treatment for hydrocephalus were intended for primary management using ETV- CPC. Patient information was prospectively entered into a database. Outcomes were evaluated by life table analysis. Potential predictors for treatment failure were evaluated using multivariate logistic regression. RESULTS: Ninety-three patients had a completed ETV- CPC with > 1 month of follow-up. The ETV- CPC procedure was successful in 71 patients (76%), with a mean and median follow-up of 19.0 months. Treatment failures occurred before 6 months in 86% of the patients, and none occurred after 10 months. The operative mortality rate was 1.1%, and there were no infections. Life table analysis suggested that 72% of the patients would be successfully treated using a single ETV- CPC and 78% would remain shunt-independent with reopening of a closed ETV stoma. Multivariate logistic regression showed scarring of the cistern (p = 0.021) or choroid plexus (p = 0.026) as predictors of failure, but age at the time of surgery was not a significant predictor. CONCLUSIONS: Using ETV- CPC appears to successfully provide a more durable primary treatment of hydrocephalus for infants with spina bifida than does shunt placement. These results support ETV- CPC as the better treatment option for these children in developing countries.
|
Authors | Benjamin C Warf, Jeffrey W Campbell |
Journal | Journal of neurosurgery. Pediatrics
(J Neurosurg Pediatr)
Vol. 2
Issue 5
Pg. 310-6
(Nov 2008)
ISSN: 1933-0707 [Print] United States |
PMID | 18976099
(Publication Type: Journal Article)
|
Topics |
- Choroid Plexus
(surgery)
- Electrocoagulation
- Endoscopy
- Follow-Up Studies
- Humans
- Hydrocephalus
(etiology, mortality, surgery)
- Infant
- Kaplan-Meier Estimate
- Meningomyelocele
(complications, mortality, pathology)
- Prospective Studies
- Third Ventricle
(surgery)
- Time Factors
- Treatment Outcome
- Uganda
- Ventriculostomy
|