Rate of Head Circumference Growth as a Predictor of Shunt Dependency in Posthemorrhagic Hydrocephalus of Prematurity

The timing and indications for endoscopic third ventriculostomy (ETV) in pediatric hydrocephalus are debated. We evaluated head circumference growth as a predictor of ETV success in children with posthemorrhagic hydrocephalus (PHH). We conducted a retrospective review of 303 patients who underwent ETV from 2012 to 2021, focusing on those with intraventricular hemorrhage (IVH) and PHH. Data were collected from electronic medical records. A univariate logistic regression analyzed predictors of ETV failure, with head circumference growth rate calculated from preoperative occipito-frontal circumference measurements. Among the 303 patients, 24 had IVH and PHH. Mean gestational age was 30 weeks, with 58% male, and a mean weight of 4.48 kg at surgery. Notably, 96% (n = 23) had choroid plexus cauterization, and 46% (n = 11) underwent ventriculosubgaleal shunt. Of the 24, 67% (n = 16) required eventual ventriculoperitoneal shunt (VPS) placement, indicating ETV failure. Corrected age at ETV was younger in the failure group (0.69 months) than in the success group (2.56 months, p = 0.020, odds ratio [OR]: 1.04). Mean weight at surgery was lower for the failure group (3.85 kg vs. 5.75 kg, p = 0.036). Duration of preoperative surveillance was 1.94 months for the failure group and 5.25 months for the success group (p = 0.004). Head circumference growth rate was 1.57 mm/day in the failure group compared to 0.85 mm/day in the success group (p = 0.009, OR: 39.9). Younger corrected age, lower weight at surgery, shorter preoperative surveillance time, and faster head circumference growth rate were associated with ETV failure and ultimately VPS placement. Further analysis with a larger cohort may enhance predictions of ETV success rates.