Intracranial Neuroendoscopy in Children and Adults: Where Do the Differences Lie?

Florian Ebel; Ladina Greuter; Luigi Mariani; Raphael Guzman; Jehuda Soleman

doi:10.1016/j.wneu.2023.05.110

Intracranial Neuroendoscopy in Children and Adults: Where Do the Differences Lie?

World Neurosurg. 2023 Jun 2:S1878-8750(23)00756-8. doi: 10.1016/j.wneu.2023.05.110. Online ahead of print.

Authors

Florian Ebel¹, Ladina Greuter², Luigi Mariani³, Raphael Guzman⁴, Jehuda Soleman⁴

Affiliations

¹ Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland. Electronic address: florianebel@hotmail.com.
² Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland.
³ Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland.
⁴ Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland; Division of Pediatric Neurosurgery, University Children's Hospital of Basel, Basel, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland.

PMID: 37271259
DOI: 10.1016/j.wneu.2023.05.110

Abstract

Background: Intraventricular neuroendoscopy has evolved into an essential adjunct in neurosurgery and is used across all age groups for various indications. However, studies comparing neuroendoscopic procedures between children and adults are scarce. The aim of this study is to compare various aspects between adults and children undergoing neuroendoscopy.

Methods: We retrospectively analyzed the data from consecutive patients dichotomized into 2 cohorts, pediatric (age <18 years) and adult (age ≥18 years) groups, in whom intracranial neuroendoscopy was performed between 2013 and 2020 (pediatric group) and 2010 and 2020 (adult group).

Results: Of 132 patients who underwent intracranial neuroendoscopic surgery, 47 (35.6%) were children and 85 (64.4%) were adults. The most common indications for the children and adults were intraventricular or paraventricular tumors (23.4%) and aqueduct stenosis (40%), respectively. Their clinical condition at the last follow-up was unchanged or improved for 90.5% of the children and 92.1% of the adults. An increased endoscopic third ventriculostomy success score was predictive of endoscopic third ventriculostomy success in the pediatric cohort (odds ratio, 1.073; P = 0.043). The postoperative rates of transient (pediatric, 23.4%; adult, 18.8%) and permanent (pediatric, 0%; adult, 1.2%) complications were comparable. The rate of secondary surgery was higher for the pediatric cohort (38.3%) than for the adult cohort (17.6%).

Conclusions: The indications for neuroendoscopy vary between adults and children, although the long-term clinical outcome is comparable. The rate of secondary surgery is significantly higher for pediatric patients, especially for those aged <1 year. Because neuroendoscopy is considerably more frequent in pediatric patients, including pediatric neurosurgeons in adult neuroendoscopic cases could potentially help lower the complication rates and increase the success rates.

Keywords: Adults; Minimally invasive; Neuroendoscopy; Neurosurgery; Pediatric; Pediatric neurosurgery.