Timing of endoscopic third ventriculostomy in pediatric patients with congenital obstructive hydrocephalus: assessment of neurodevelopmental outcome and short-term operative success rate

The purpose of this study was to determine the impact of early (⩽6 months old), midterm (6–12 months old) and late (>12 months old) endoscopic third ventriculostomy (ETV) on the operative success rate and postoperative neurodevelopmental outcome of children with congenital obstructive hydrocephalus. We divided 63 children into three groups according to whether they underwent early, midterm or late ETV. Their preoperative developmental quotient (DQ) was assessed using the Gesell developmental diagnosis schedule (GDDS). Three and 6 months after the initial procedure, GDDS was used to obtain postoperative DQ from two assessments (blinded and non-blinded). Meanwhile, two observers studied the operative success rate of initial ETV. There were no substantial differences between blinded and non-blinded assessments. The success rate of early ETV was only 20.8%. By contrast, this rate was 55% and 73.7% for midterm and late ETV, respectively. Before operation, we observed severe developmental abnormalities in all children (DQ score < 40). However, children in midterm and late ETV groups achieved improvement after the operation, which was particularly remarkable in late ETV group. Six months after the first surgery, 16 (84.2%) children in the late ETV group, nine (45%) in the midterm ETV group and four (16.7%) in the early ETV group had moderate developmental disability. Nevertheless, overall prognosis for the three groups was not optimistic. There were no children with mild neurodevelopmental disability or normal function. Our data confirmed that age is a determinant for ETV effectiveness and overall prognosis.