Hi!
The paper by Kulkarni et al in Neurosurgery Aug 2010 addresses this interesting question - they compared the failure rate of endoscopic third ventriculosomty (ETV, n = 489) vs cerebrospinal fluid shunt (n = 720), i.e, totally 1209 children.
They found:
1. ETV has a higher rate of early postoperative failure relative to shunt. This early risk of failure is at least 20% higher than shunt; ie, the early hazard ratio is > 1.2. The authors interprete that this likely reflects the selection of patients for whom ETV was physiologically unsuitable.
2. After about 3 months, the relative risk of failure of ETV is lower than that of shunt and then becomes progressively lower with more time. At 2 years, for example, the risk of ETV failure is roughly half the risk of shunt failure.
The authors conclude that if patients survive the early high-risk period of ETV failure, they could experience long-term treatment survival advantage compared with shunt. It might take several years, however, for this survival advantage to be realized.
Reference:
Kulkarni et al. Endoscopic Third Ventriculostomy Vs Cerebrospinal Fluid Shunt in the Treatment of Hydrocephalus in Children: A Propensity Score–Adjusted Analysis
Neurosurgery 67(3):588-593, 2010.
Click here to read abstract.
|