Staying out of the Hospital: Comparing Hydrocephalus Treatments in the Pediatric Population

By Jessica Moser

A Hydrocephalus Clinical Research Network (HCRN) study with lead author Dr. Jonathan Pindrik was recently published in the Journal of Neurosurgery:  Pediatrics. The study looked at differences in the number of subsequent surgeries a child had to undergo after the initial treatment of hydrocephalus. Each child was treated with a shunt, an endoscopic third ventriculostomy (ETV), or an ETV with choroid plexus cauterization (ETV-CPC). Choroid plexus is a type of tissue that produces cerebrospinal fluid (CSF). Cauterizing the choroid plexus reduces the production of CSF in the ventricular system.

What they did

This study, published in June of 2020, used data collected from the HCRN’s database to determine which treatment for hydrocephalus had the least amount of subsequent surgeries and hospital admission days related to surgery. Patients had to receive treatment before reaching 24 months of age. Data were collected on what caused the hydrocephalus, age, ethnicity, and clinical outcomes following the surgery after 1, 3, and 5 years. The follow-up data included the number of hydrocephalus surgeries and related hospital admission days.

What they found

1,090 patients were included in this study. 83.5 percent of them received shunts, 10 percent an ETV with CPC, and 6.5 percent an ETV alone. Over 50 percent of the patients were less than one month old at the initial treatment, and 90 percent of the patients were less than a year old. The cause of hydrocephalus was primarily posthemorrhagic hydrocephalus (PHH) (26 percent) and myelomeningocele (23 percent). 

Patients who had an ETV-CPC had to undergo more surgeries, on average, than either shunted patients or those who had an ETV alone within the first year. The number of days spent in the hospital was not significantly different between the three groups. Shunt revisions and insertions accounted for over 75 percent of surgeries performed in the first year after the initial treatment. This includes shunt revisions, shunt insertion following a shunt infection, and first shunt placement after a failed ETV or ETV-CPC.

Within three years of the initial surgery, the ETV group had fewer hospital admission days than the CSF shunt group. Although not statistically significant, patients with an ETV alone experienced fewer revisions than shunted patients at the three and five-year follow ups as well. ETV-CPC was not included in the three and five-year follow up analysis due to inadequate duration of follow up.

This study indicates that there may be a time-dependent benefit of ETV, and potentially ETV-CPC (in future long-term studies), procedures over shunt insertion which is consistent with previously published studies. However, if these treatment types fail, shunt placement remains the alternative treatment option. In addition, the authors note that, the ETV-CPC data (higher surgical utilization at 1 year) may not reflect current practices as ETV-CPC is now performed on a more narrowly defined patient population who tend to have better outcomes.

The full study can be found at: https://pubmed.ncbi.nlm.nih.gov/32559741/

About the HCRN

The Hydrocephalus Clinical Research Network (HCRN) is a network of fourteen children’s hospitals that conduct clinical research to improve the lives of children suffering from hydrocephalus. The HCRN has published 23 studies since its inception in 2005.  The Hydrocephalus Association has provided over $2 million to support the HCRN since 2009.

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