The Impact of Endoscopic Third Ventriculostomy on Shunt Revision Rate: A 14-Year Experience at a Single Institution.

ABSTRACT

BACKGROUND: Shunt-related procedures in the treatment of hydrocephalus are often associated with malfunction and revision resulting in significant patient morbidity and financial impact on the health care system. The increased utilization of endoscopic third ventriculostomy (ETV) as an alternative treatment paradigm for obstructive hydrocephalus carries the theoretical expectation of concomitant decreased numbers of shunt procedures. The objective of the present study was to determine the impact of ETV on shunt-related procedures within a 14-year interval (1998-2011), during which ETV has gained wider acceptance and greater utilization. METHODS: This retrospective chart review describes the annual rate of pediatric patients who underwent either ETV or shunt-related procedures at New York Presbyterian Hospital Weill-Cornell Medical Center. Statistical analyses were done to analyze possible correlation between relative rates of these cases. RESULTS: During the 14-year study period, 954 procedures were performed for the treatment of hydrocephalus (159 ETVs and 795 shunt-related procedures). Of the shunts, 356 were initial insertions and 439 were revisions. The number of ETVs increased from 8 procedures in 1998/1999 to 34 in 2010/2011, whereas the total number of annual shunt-related procedures decreased from 146 to 99. The relative ratios of ETVs and shunt-related procedures to the total number of cases demonstrate an inverse relationship over time (Spearman correlation coefficient rs = -1.0; P = 0.0004). CONCLUSIONS: Based on prior cost-effectiveness analyses, the observed trend of the inverse correlation between ETVs and shunt-related procedures may contribute to financial savings and improvement in patient outcomes. Further study is required to define the impact on morbidity and associated success rates.