P.027 Comparative effectiveness of flexible vs. rigid neuroendoscopy for ETV/CPC: a propensity score matched cohort and survival analysis. (2nd June 2017)

• Record Type: Journal Article
• Authors: Wang, S; Stone, S; Weil, AG; Fallah, A; Warf, BC; Ragheb, J; Bhatia, S; Kulkarni, AV
• Is Part Of: Canadian journal of neurological sciences. Volume 44(2017)Supplement 2
• Page Start: S20
• Page End: S20
• Publication Date: 2017-06-02
• Subjects: Neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; Electronic journals; 616.8
• DOI: 10.1017/cjn.2017.112
• Languages: English
• ISSNs: 0317-1671

Abstract

Abstract : Background: ETV/CPC has become an increasingly common technique for the treatment of infant hydrocephalus. Both flexible and rigid neuroendoscopy can be used, with little empirical evidence directly comparing the two. We, therefore, used a propensity-matched cohort and survival analysis to assess the comparative efficacy of flexible and rigid neuroendoscopy.Methods: Individual data were collected through retrospective review of infants < 2 years of age, treated at one of 2 hospitals: 1) Boston Children's Hospital, exclusively utilizing flexible neuroendoscopy, and 2) Nicklaus Children's Hospital, exclusively utilizing rigid neuroendoscopy. Patient characteristics and post-operative outcome were assessed. A propensity score (PS) model was developed to balance patient characteristics in the case mix.Results: A PS model was developed with 5 independent variables: chronological age, sex, hydrocephalus etiology, prior CSF diversion, and prepontine scarring. PS analysis revealed that compared to flexible neuroendoscopy, rigid neuroendoscopy had an ETV/CPC failure OR of 1.43 and 1.31 respectively, compared to unadjusted OR of 2.40. Furthermore, in a Cox regression analysis controlled by propensity score, rigid neuroendoscopy had a HR of 1.10, compared to unadjusted HR of 1.61.Conclusions: Much of the difference in ETV/CPC outcome between endoscopy types is attributed to the case mix. An observational study or randomized controlled trial is required to provide evidence-based guidelines.