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FOCUS SESSION
Why a Focus Session on endoscopic third ventriculostomyin infants?
Wolfgang Wagner
Received: 28 October 2005 / Published online: 30 August 2006# Springer-Verlag 2006
Since its “renaissance” in the late 1980s, endoscopic thirdventriculostomy (ETV) gained a growing acceptance and,eventually, an established place in the surgical treatment ofobstructive hydrocephalus. It soon became clear, however,that a part of the patients undergoing that endoscopicprocedure eventually failed and that the chance of curingthe hydrocephalus by endoscopy alone (without a shunt)depended on several factors, from which patient’s age andetiology of hydrocephalus are the most important.
Most pediatric neurosurgeons agree that ETV has ahigher failure rate in infants as opposed to children,adolescents, or adults. As some of us (not all) have foundvery low success rates in the first months of life, thequestion of whether this procedure should be offered at allto our youngest patients or whether it should be reserved toinfants beyond the first or second year of life was raised.Similar considerations concern the role of etiology: there isgeneral consensus that patients with isolated aqueductal
stenosis are “good candidates” for ETV, whereas newbornswith hydrocephalus in the context of myelomeningoceleshould be treated with shunts. But what kind of treatmentshould be chosen in other etiologies? How should mixedforms of obstructive/absorptive hydrocephalus be dealtwith? Which kind of preoperative imaging is indispens-able? Are there differences between ETV and shunts in thefirst year of life, with respect to complications or neurologiclong-term outcome?
This series of articles is intended to give an actualoverview over the different important aspects of ETV ininfants, particularly in the first year of life. The role ofpreoperative imaging, frequency and type of complications,and neurologic development after ETV vs shunt are dealtwith, as well as the impact of age on success rate,indications for ETV in pathologies different from isolatedaqueductal stenosis, or the relevance of a “spectrumclassification” of absorptive vs obstructive hydrocephalusfor the choice of the appropriate treatment procedures.
Of course, this Focus Session not only gives more or lessestablished answers, but also addresses questions that stillremain open. In particular, the important issue of finalneurodevelopmental outcome of children treated by ETVorshunt can be dealt with only by a prospective andrandomized study, following the patients over years, as isintended to be realized by the ongoing International InfantHydrocephalus Study (IIHS). While this Focus Sessionreflects our present knowledge, we are optimistic that thefuture will clarify questions that at the moment must be leftunanswered.
Childs Nerv Syst (2006) 22:1527DOI 10.1007/s00381-006-0188-2
W. WagnerSection of Paediatric Neurosurgery, Department of Neurosurgery,University Hospital Mainz,Mainz, Germany
W. Wagner (*)Neurochirurgische Klinik und Poliklinik,Bereich Pädiatrische Neurochirurgie,Johannes Gutenberg-Universität,Langenbeckstrasse 1,55131 Mainz, Germanye-mail: wagner@nc.klinik.uni-mainz.de
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