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梗阻性脑积水内镜下第三脑室造瘘术失败的危险因素。

Risk factors for failure of endoscopic third ventriculostomy for obstructive hydrocephalus.

作者信息

Fukuhara T, Vorster S J, Luciano M G

机构信息

Department of Neurosurgery, The Cleveland Clinic Foundation, Ohio 44195, USA.

出版信息

Neurosurgery. 2000 May;46(5):1100-9; discussion 1109-11. doi: 10.1097/00006123-200005000-00015.

Abstract

OBJECTIVE

This is a retrospective study to identify risk factors for failure in the treatment of obstructive hydrocephalus with endoscopic third ventriculostomy (ETV).

METHODS

The records for 89 patients, including 32 with ventriculoperitoneal or ventriculoatrial shunt malfunctions or infections, who underwent ETVs between 1993 and 1998, at our institution, were examined. Multiple variables possibly related to failure were considered. These included age, sex, cause of hydrocephalus, presence and function of ventriculoperitoneal/ventriculoatrial shunts, history of shunt revisions or infections, symptoms, preoperative imaging results, presence of retained shunt catheters, postoperative meningitis, and postoperative ventricular size.

RESULTS

Twenty-nine patients (32.6%) required subsequent shunt replacement and/or ETV revision. Of these 29 reoperations, 12 procedures (41.4%) were performed within 2 weeks and only 3 were performed more than 10 months after the initial ETV procedure. The ventricular size remained unchanged in 75% of the cases on the day after ETV, in 57.4% at 3 months, in 48.2% at 6 months, and in 41.8% at 1 year. Cine phase-contrast magnetic resonance imaging findings were consistent with postoperative symptomatic resolution in 96.3% of the cases. Seven patients (7.9%) experienced complications related to ETV, all of which were transient. Significant risk factors in univariate analyses were as follows: presence of Chiari Type I malformation (P = 0.003), shunt infection at presentation (P = 0.014), history of shunt infections (P = 0.0004), three or more previous shunt revisions (P = 0.0018), and postoperative meningitis (P = 0.0001). Late-onset idiopathic aqueductal stenosis was a significant predictor of good outcomes (P = 0.044). These factors were reanalyzed in a multivariate analysis, which confirmed a history of shunt infections and postoperative meningitis as independent risk factors.

CONCLUSION

The risk of failure increases with intracerebral infection, likely because of obliteration of cerebrospinal fluid pathways.

摘要

目的

这是一项回顾性研究,旨在确定内镜下第三脑室造瘘术(ETV)治疗梗阻性脑积水失败的危险因素。

方法

检查了1993年至1998年间在我们机构接受ETV手术的89例患者的记录,其中包括32例脑室腹腔或脑室心房分流故障或感染患者。考虑了多个可能与失败相关的变量。这些变量包括年龄、性别、脑积水病因、脑室腹腔/脑室心房分流的存在和功能、分流修正或感染史、症状、术前影像学结果、保留分流导管的存在、术后脑膜炎以及术后脑室大小。

结果

29例患者(32.6%)需要后续进行分流置换和/或ETV修正。在这29例再次手术中,12例手术(41.4%)在2周内进行,只有3例在初次ETV手术后10个月以上进行。ETV术后第1天,75%的病例脑室大小保持不变;3个月时为57.4%;6个月时为48.2%;1年时为41.8%。电影相位对比磁共振成像结果在96.3%的病例中与术后症状缓解一致。7例患者(7.9%)出现与ETV相关的并发症,均为短暂性。单因素分析中的显著危险因素如下:存在Chiari I型畸形(P = 0.003)、就诊时分流感染(P = 0.014)、分流感染史(P = 0.0004)、既往三次或更多次分流修正(P = 0.0018)以及术后脑膜炎(P = 0.0001)。迟发性特发性导水管狭窄是良好预后的显著预测因素(P = 0.044)。在多因素分析中对这些因素进行了重新分析,证实分流感染史和术后脑膜炎是独立的危险因素。

结论

失败风险随着颅内感染而增加,可能是由于脑脊液通路闭塞所致。

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