1330. Predictors of Need For Repeat ETV and Shunt Placement in Patients with Prior ETV Procedures: A Logistic Regression

Authors: Daniel Blatt; James Obayashi, BS; Mako Gedi, BS; Christina Sayama, MD, MPH (Portland, OR)

Endoscopic third ventriculostomy (ETV) is an important treatment for pediatric hydrocephalus, and can prevent ventriculoperitoneal shunt placement. Prior studies have demonstrated that increasing age, obstructive etiology, and no prior shunts all increase the likelihood of successful ETV treatment for hydrocephalus. However, it is not clear if or what 13 chronic complex conditions (CCC’s) categories affect ETV treatment outcomes.

This is a retrospective cohort study to assess two endpoints; (1) what CCC’s are associated with repeat ETV procedures, and (2) what CCC’s are associated with shunt placement following an ETV.

We obtained data for 164 patients age 0-17 with hydrocephalus without a prior shunt treated at our institution between 2008-2016. The variables collected were; demographics, etiology of hydrocephalus, number and types of chronic complex conditions, number of ETV’s performed, and if subsequent shunt placement occurred.

Two statistical analyses were performed. The first was a logistical regression to identify variables associated with repeat ETV procedures. The second was a logistical regression to identify variables associated with shunt placement following ETV procedure(s).

The total success rate of one or more ETV’s without shunt placement was 71.9% (118/164). A majority of patients with repeat ETV’s remained shunt free (22/37, 59.5%). 

Only neuromuscular CCC’s were significantly associated with repeat ETV procedures (p=0.007). Eighteen such patients were present in our analysis, and fifteen had myelomeningocele. One variable was associated with eventual shunt placement – Age at presentation (p=0.004).  It was found that for every year older the patient was at time of ETV, the odds of future shunt placement decreased.

Our analysis confirms prior studies, demonstrating that patients with neuromuscular disorders, particularly myelomeningocele, are more likely to require repeat ETV’s. Our study also confirms prior knowledge that with increasing age, patients are less likely to require shunt placement following an ETV.