A Medline search discovered 24 series of ETV (seven in children, five in adults, and 12 in a mixed-age group) with detailed complications reports.
RESULTS: The analysis included 2,672 ETVs performed on 2,617 patients. The cause of
hydrocephalus was
aqueductal stenosis in 25.9%,
tumor 37.0%,
meningomyelocele-Chiari II 6.1%, posthemorrhagic 5.8%, postinfectious 1.4%,
cysts 3.3%, Chiari I 0.4%,
Dandy-Walker malformation 0.3%, cerebellar
infarct 0.9%,
normal pressure hydrocephalus 1.3%, and not recorded 16.8%. Overall complication rate was 8.8%. Permanent morbidity was 2.1%, neurologic in 1.2% (
hemiparesis, gaze
palsy,
memory disorders, and/or altered consciousness), hypothalamic in 0.9% (
diabetes insipidus,
weight gain, or
precocious puberty). Intraoperative
hemorrhage was present in 3.9%, severe in 0.6% (including four cases [0.14%] of basilar
rupture). Other surgical complications were 1.13% (three thalamic
infarcts, six subdural, six intracerebral, and two epidural
hematomas). Cerebrospinal fluid (CSF)
infections occurred in 1.8%, CSF leak in 1.7%,
anesthetic complications (
bradycardia and
hypotension) in 0.19% of cases. Postoperative mortality was 0.22% (six patients;
sepsis two,
hemorrhage three, and thalamic injury one). Another two children suffered delayed "
sudden death" (after 25 and 60 months), caused by acute
hydrocephalus due to stoma occlusion. There were no differences between pediatric and adult patients or short and long series (cutoff 100 patients). All deaths were reported in long series. Complication rates were insignificantly higher in short series.
CONCLUSIONS: