Third ventriculostomy versus cerebrospinal fluid shunt as a first procedure in pediatric hydrocephalus

Background: Third ventriculostomy (TV) has been reported to be efficacious for diverse causes of obstructive hydrocephalus in pediatric patients, and preferable to a first CSF shunt (CS) in those eligible. We reviewed the res pective failure rates in a prospective cohort of patients at our institutio n. Method: All patients having either TV or CS (i.e ventriculoperitoneal sh unt) over the period 1987 to 1997 were prospectively entered into a databas e. To compare homogeneous patients, only diagnoses of either aqueductal ste nosis or tumor were considered. Failure was defined as any subsequent surgi cal procedure for CSF diversion. Kaplan-Meier curves were constructed to de termine survivorship. A multivariable Cox model using time-dependent covari ates was constructed. Results: There were 32 TV and 210 CS patients: 14 (44 %) and 95 (45%) failed, respectively. TV patients were older (median age = 8.1 vs, 3.6 years) and had a higher incidence of aqueductal stenosis (53 vs . 25%). There was no statistically significant difference between the two p rocedures based on bivariate analysis (p = 0.87) and on multivariable analy sis using the Cox model after adjusting for the potential confounders (p = 0.66, hazard ratio = 1.19, 95% confidence interval = 0.55-2.56). Conclusion : Failure from TV is not unlike that of CS when analyzed by survival method s, Larger prospective series are needed to look at specific subgroups who m ay benefit from TV. Quality of life and clinical outcome measures are also required to analyze the difference between these two procedures.