Santamarta D, Díaz Alvarez A, Gonçalves J M, Hernández J
Department of Neurosurgery, Hospital Universitario de Salamanca, Virgen de la Vega, Spain.
Acta Neurochir (Wien). 2005 Apr;147(4):377-82; discussion 382. doi: 10.1007/s00701-005-0484-8.
Endoscopic third ventriculostomy (ETV) has gained acceptance as the treatment of choice for noncommunicating hydrocephalus despite a relatively high failure rate and a higher surgical risk than the placement of a shunt. The benefits of shunt independence overcome both drawbacks. This argument also serves to consider candidates for ETV patients with a poor chance of success, a fact which may to a certain degree explain failure rates higher than 20% in most unselected series of patients with noncommunicating hydrocephalus.
From 1997 to 2003 sixty-six patients with suspected noncommunicating hydrocephalus were treated with ETV. Male and female patients were equally distributed. It is an adult-based series (median age 53 years). The etiology of hydrocephalus was a space-occupying lesion in 39 patients (59%) and primary aqueductal stenosis in 27 (41%). Forty-seven patients presented an acute form of hydrocephalus (71%), the remainder presented a chronic form of hydrocephalus. The morbidity and outcome of the procedure were reviewed. Criteria for success was shunt independence and failure was considered when any surgical manoeuvre was further required for the treatment of hydrocephalus. The outcome was evaluated using the Kaplan-Meier survival method.
The probability of remaining with a functioning ETV at 5.7 years (mean follow-up period) is 71.6% (95% confidence interval: 60.5-82.8). Failure occurred in 18 patients (27.3%). If failure occurs, there is a cumulative probability of 90% (95% confidence interval: 84-97) that the failure declares itself during the first 16 days after surgery. There were transient complications in five patients (7.5%), permanent in one (1.5%) and no mortality related to the procedure.
ETV had a 5-year success rate of 71.6% with a low rate of permanent complications. When ETV is successful, the result tends to hold up over time. Delayed failure is a rare event.
尽管内镜下第三脑室造瘘术（ETV）的失败率相对较高且手术风险高于分流术，但它已成为非交通性脑积水的首选治疗方法。分流独立的益处克服了这两个缺点。这一观点也有助于考虑成功几率较低的ETV患者，这一事实在一定程度上可以解释大多数未经筛选的非交通性脑积水患者系列中高于20%的失败率。
1997年至2003年，66例疑似非交通性脑积水患者接受了ETV治疗。男性和女性患者分布均匀。这是一个以成年人为主的系列（中位年龄53岁）。脑积水的病因是39例（59%）为占位性病变，27例（41%）为原发性导水管狭窄。47例患者表现为急性脑积水（71%），其余患者表现为慢性脑积水。回顾了该手术的发病率和结果。成功标准为分流独立，当脑积水治疗需要进一步的手术操作时则视为失败。使用Kaplan-Meier生存方法评估结果。
在5.7年（平均随访期）时，ETV仍发挥作用的概率为71.6%（95%置信区间：60.5 - 82.8）。18例患者（27.3%）出现失败。如果发生失败，在术后前16天内失败的累积概率为90%（95%置信区间：84 - 97）。5例患者（7.5%）出现短暂并发症，1例（1.5%）出现永久性并发症，且无与手术相关的死亡。
ETV的5年成功率为71.6%，永久性并发症发生率低。当ETV成功时，结果往往会随着时间推移而维持。延迟失败是罕见事件。
