Evaluation of the endoscopic third ventriculostomy success score for stereotactic prepontine stenting in patients with aqueductal stenosis

Ueberschaer, Moritz; Wirthensohn, Katja; Niedermeyer, Sebastian; Forbrig, Robert; Thon, Niklas; Kirchleitner, Sabrina Viktoria; Kunz, Mathias; Hitzl, Wolfgang; Schmutzer-Sondergeld, Michael (2026): Evaluation of the endoscopic third ventriculostomy success score for stereotactic prepontine stenting in patients with aqueductal stenosis. Brain and Spine, 6: 106031. ISSN 2772-5294

Abstract

Introduction

Stereotactic prepontine stenting (STS) has been shown to be a safe and effective alternative treatment to standard endoscopic third ventriculostomy (ETV) for the treatment of triventricular hydrocephalus (TVH). For ETV a success score (ETVSS) allows risk stratification for treatment failure, which was validated in young patients. For patients with TVH treated with STS a comparable success score was not performed to date. This was the reason why we wanted to test whether the ETVSS is also applicable to this patient cohort.

Research question

Is the ETVSS also eligible for patients undergoing STS?

Methods

TVH patients undergoing either ETV or STS between 2013 and 2024 were included retrospectively. Treatment failure was defined as absence of symptomatic and/or imaging improvement. ETVSS and its predicitive power were calculated for each group and correlated with outcome. Further statistical models were applied to create alternative scores.

Results

50 STS patients had a mean ETVSS of 88.2 ± 3.9% compared to 81.8 ± 16.7% in 97 patients undergoing ETV (p = 0.009). Successful treatment was achieved in 87% of ETV and 96% of STS patients (p = 0.09). Mean ETVSS after successful treatment was 89.1 ± 2.9% versus 81.7 ± 4.1% with treatment failure in the STS and 84.1 ± 13.5% versus 71.7 ± 24.8% in the ETV group (p = 0.02 and p = 0.3). ROC analysis showed varied performance of ETVSS in the STS (AUC = 0.553) and ETV cohort (AUC = 0.766). Univariate analysis showed significant influence of the clivus-basilar artery diameter on treatment success in the ETV group. Identified risk factors did not allow the establishment of new scores.

Conclusion

ETVSS did not enable prediction of treatment success by STS. Individual decision-making is essential, especially in patients with low ETVSS. Future studies must include a more heterogeneous patient population to enable new scoring systems specifically for patients undergoing STS.

• Dokumententyp: Artikel (Klinikum der LMU)
• Organisationseinheit (Fakultäten): 07 Medizin > Klinikum der LMU München > Neurochirurgische Klinik und Poliklinik
• DFG-Fachsystematik der Wissenschaftsbereiche: Lebenswissenschaften
• DFG: Gefördert durch die Deutsche Forschungsgemeinschaft (DFG) - 491502892