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Improving outcomes in pediatric endoscopic third ventriculostomy through outcome analysis and surgeon training

PhD ceremony:Mr G.E. (Gerben) Breimer
When:January 11, 2017
Supervisors:prof. dr. E.W. Hoving, prof. dr. J.M. Drake
Where:Academy building RUG
Faculty:Medical Sciences / UMCG

One of the treatment options of hydrocephalus is using an endoscope to puncture the floor of the third ventricle in the brain. This procedure is called an endoscopic third ventriculostomy (ETV). It is an effective but technically demanding procedure with significant risks. It is important to select the right patient for this procedure and that the surgeon masters the technique. The focus of this thesis is on these two issues.

For patient selection, we tested a score system to predict chances of ETV success, the ETV success score (ETVSS). A patient with a high score is a good candidate. We analyzed the predictive accuracy of the ETVSS in a Dutch cohort and found that the score predicts success reliably. However, some patients develop recurrent symptoms of hydrocephalus for which additional treatment is needed. We found that for these patients, again, the ETVSS accurately predicts the chance of success.

The endoscopic technique requires different hand-eye coordination skills than open procedures and mastering ETV requires training. A pilot needs to train extended periods in a flight-simulator before getting responsibility over an airplane. Why is this not the same for a surgeon? To facilitate this and to create a risk-free training environment we used 3d-printtechnology to create a silicon replica of a brain. We also developed a standardized assessment instrument to evaluate the surgeons’ skills and techniques. Maybe in the future, neurosurgeons will be required to score well on such an assessment instrument before getting the responsibility over an actual patient.