Inferior short-term safety profile of endoscopic third ventriculostomy compared with ventriculoperitoneal shunt placement for idiopathic normal-pressure hydrocephalus: a population-based study.
نویسندگان
چکیده
BACKGROUND In small series, endoscopic third ventriculostomy (ETV) has been shown to potentially have efficacy similar to that of ventriculoperitoneal shunting (VPS) for idiopathic normal-pressure hydrocephalus (iNPH). Therefore, some clinicians have advocated for ETV to avoid the potential long-term complications associated with VPS. Complication rates for these procedures vary widely based on limited small series data. OBJECTIVE We used a nationwide database that provides a comprehensive investigation of the perioperative safety of ETV for iNPH compared with VPS. METHODS We identified discharges with the primary diagnosis of iNPH (International Classification of Diseases, Ninth Revision code 331.5 [ICD-9]) with ICD-9 primary procedure codes for VPS (02.34) and ETV (02.2) from 2007 to 2010. We analyzed short-term safety outcomes using univariate and hierarchical logistic regression analyses. RESULTS There were a total of 652 discharges for ETV for iNPH and 12,845 discharges for VPS for iNPH over the study period. ETV was associated with a significantly higher mortality (3.2% vs 0.5%) and short-term complication (17.9% vs 11.8%) rates than VPS despite similar mean modified comorbidity scores. On multivariate analysis, ETV alone predicted increased mortality and increased length of stay when adjusted for other patient and hospital factors. CONCLUSION This is the first study that robustly assesses the perioperative complications and safety outcomes of ETV for iNPH. Compared with VPS, ETV is associated with higher perioperative mortality and complication rates. This consideration is important to weigh against the potential benefit of ETV: avoiding long-term shunt dependence. Prospective, randomized studies are needed.
منابع مشابه
Comparing the Efficiency of Two Treatment Methods of Hydrocephalus: Shunt Implantation and Endoscopic Third Ventriculostomy
Introduction: Hydrocephalus is one of the most common diseases in children, and its treatment requires brain operation. However, the pathophysiology of the disease is very complicated and still unknown. Methods: Endoscopic Third Ventriculostomy (ETV) and Ventriculoperitoneal Shunt (VPS) implantation are among the common treatments of hydrocephalus. In this study, Cerebrospinal Fluid (CSF) hyd...
متن کاملJournal club: role of endoscopic third ventriculostomy and ventriculoperitoneal shunt in idiopathic normal pressure hydrocephalus: preliminary results of a randomized clinical trial.
متن کامل
Role of endoscopic third ventriculostomy and ventriculoperitoneal shunt in idiopathic normal pressure hydrocephalus: preliminary results of a randomized clinical trial.
BACKGROUND Currently, the most common treatment for idiopathic normal pressure hydrocephalus (INPH) is a ventriculoperitoneal shunt (VPS), generally with programmable valve implantation. Endoscopic third ventriculostomy (ETV) is another treatment option, and it does not require prosthesis implantation. OBJECTIVE To compare the functional neurological outcome in patients after 12 months of tre...
متن کاملSuccess rates and complications of ventriculoperitoneal and ventriculoatrial shunting: A systematic review
Background and Aims: The insertion of ventriculoperitoneal (VP) and ventriculoatrial (VA) shunts is the first-line treatment of patients with hydrocephalus and normal-pressure hydrocephalus. The provision of a safety profile for shunting in the treatment of hydrocephalus patients is very important. This study aimed to determine the success rates and complications of VP and VA shunting in patien...
متن کاملA Case and Literature Review of Normal Pressure Hydrocephalus in Mixed Connective Tissue Disease
Normal Pressure hydrocephalus (NPH) is characterized by gait apraxia, urinary incontinence, and dementia. Mixed connective tissue disease (MCTD) is an autoimmune connective tissue disease that has never been reported to cause NPH. Our patient was a 67-year man with a one-year history of gradual worsening gait and balance, urinary urgency with urge incontinence and decreased short-term memory. P...
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ورودعنوان ژورنال:
- Neurosurgery
دوره 73 6 شماره
صفحات -
تاریخ انتشار 2013