Avaliação dos fatores relacionados ao sucesso da terceiro ventriculostomia endoscópica na hidrocefalia associada à mielomeningocele

Abstract

Introduction: Myelomeningocele (MMC) is the most common neural tube defect compatible with life, and one of its most frequent complications is the occurrence of hydrocephalus (HCF), especially in patients whose defect correction took place in the postnatal period. The standard treatment for this population is still the insertion of a ventriculoperitoneal shunt (VPS), but it is associated with complications and higher morbidity and mortality. As an alternative to DVP, endoscopic third ventriculostomy (ETV) stands out, it is a procedure without the need for an implantable device, but its success rate is inconsistent in the medical literature. Objectives: To evaluate the success rate of EVT in the treatment of hydrocephalus associated with MMC and to identify possible clinical and/or radiological features associated with ETV success. Methods: Twenty-one patients with myelomeningocele, born between 2015 and 2021, that underwent EVT for hydrocephalus were included in this study. Patients with fetal MMC correction were excluded. Clinical data such as head circumference at birth and preoperatively, prematurity, presence of previous VPS, number of previous revisions, presence of a previous infection, age at the time of ETV, in addition to radiological factors such as the Evans index, clivo-occipital angle, the estimated volume of the posterior fossa and estimated volume of the supratentorial compartment were analyzed. Results: The six-month success rate was 61.9%, the overall success rate was 57.1%, and the mean calculated ETVSS was 46.7%. The only factor with apparent relevance to the success of ETV was age: the patients older than six full months had a success rate of 76.9%, while the younger ones had a success rate of 25% (OR: 0.03; 95% CI 0.01-0.35; p = 0.013). No radiological features were identified as associated with the procedure's success. Conclusions: The only factor of statistical relevance with the success of TVE was age, with patients younger than six full months of age having a higher probability of failure. The ETVSS, on the other hand, underestimated the procedure's success rate at six months, which shows a need for modifications to improve its results when applied in younger patients.