Long-term outcome and neurologic development after endoscopic third ventriculostomy versus shunting during infancy.

INTRODUCTION

Infants with obstructive hydrocephalus who were under 9 months old were initially treated by neuroendoscopic third ventriculostomy (ETV) after evaluation with magnetic resonance imaging (MRI). The clinical course and long-term outcome of these infants were examined. The outcome was also compared with that of similar infants who received ventriculoperitoneal shunting.

METHODS

The patients were divided into three groups based on MRI findings: Group I was made up of six patients in whom mainly the frontal horns of the lateral ventricles were enlarged and the morphology of the cerebral cortex was normal; group II was made up of 13 patients in whom the entire lateral ventricle was enlarged bilaterally and the morphology of the cerebral cortex relatively normal; and group III was made up of six patients in whom the entire lateral ventricle was markedly enlarged bilaterally and there was periventricular leakage of cerebrospinal fluid.

RESULTS

In group I, two patients were treated conservatively and four patients were treated with ETV. All of the patients in this group showed virtually normal development at 4 years of age. In group II, development was still delayed in six patients at 1 year after ETV, and two of these patients underwent shunting. All of the patients in this group showed near normal development at 5 to 6 years of age. In group III, all of the patients underwent shunting within 1 year after ETV because there was no appreciable improvement of development at 6 months after the initial procedure.

CONCLUSIONS

In infants with obstructive hydrocephalus in whom the cerebral cortex is intact, adequate development can be achieved with ETV alone, although catch-up tends to be slow. In infants in whom cerebral development is inadequate or in whom the cerebrum has already been affected by hydrocephalus, sufficient improvement of development cannot be achieved with ETV alone, even if the intracranial pressure is controlled. It seems that early shunting is more useful for achieving cerebral recovery in this patient group.