ArticleBrain & spine2026
Evaluation of the endoscopic third ventriculostomy success score for stereotactic prepontine stenting in patients with aqueductal stenosis.
Article in Brain & spine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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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.
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