How should we treat long-standing overt ventriculomegaly in adults (LOVA)? A retrospective cohort study

• Published in: Neurosurgical review Vol. 45; no. 5; pp. 3193 - 3200
• Main Authors: Gillespie, Conor S., Richardson, George E., Mustafa, Mohammad A., Evans, Daisy, George, Alan M., Islim, Abdurrahman I., Mallucci, Conor, Jenkinson, Michael D., McMahon, Catherine J.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.10.2022
• Subjects: Adult; Humans; Hydrocephalus - etiology; Male; Medicine; Medicine & Public Health; Middle Aged; Neurosurgery; Original; Original Article; Retrospective Studies; Ventriculoperitoneal Shunt; Ventriculostomy - adverse effects; Aqueduct stenosis; Hydrocephalus; LOVA; Chronic hydrocephalus; Long-standing overt ventriculomegaly in adults; Arrested hydrocephalus
• ISSN: 1437-2320; 0344-5607; 1437-2320
• DOI: 10.1007/s10143-022-01812-5

Long-standing overt ventriculomegaly in adults (LOVA) is a heterogenous group of conditions with differing presentations. Few studies have evaluated success rates of available surgical treatments, or ascertained the natural history. There is a need to assess the efficacy of both endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunt (VPS) as first-line treatments. We conducted a retrospective, single-centre study of adults with LOVA at a tertiary neurosurgery centre in England, UK, aiming to identify presentation, management strategy, and outcome following treatment. A total of 127 patients were included (mean age 48.1 years, 61/127 male). Most patients were symptomatic (73.2%, n = 93/127, median symptom duration 10 months). The most common symptoms were gait ataxia, headache, and cognitive decline (52.8%, 50.4%, and 33.9%, respectively). Fourteen patients had papilloedema. Ninety-one patients (71.7%) underwent surgery (84 ETV, 7 VPS). Over a median follow-up of 33.0 months (interquartile range [IQR] 19.0–65.7), 82.4% had a clinical improvement after surgery, and 81.3% had radiological improvement. Clinical improvement rates were similar between ETV and VP shunt groups (82.1% vs 85.7%, p = 0.812). Surgical complication rates were significantly lower in the ETV group than the VP shunt group (4.8% vs 42.9%, p < 0.001). Of the patients treated surgically, 20 (22.0%) underwent further surgery, with 14 patients improving. This study demonstrates the efficacy of ETV as a first-line treatment for LOVA.