Fritsch Michael J, Kienke Sven, Ankermann Tobias, Padoin Maurizio, Mehdorn H Maximilian
Department of Neurosurgery, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany.
J Neurosurg. 2005 Jul;103(1 Suppl):50-3. doi: 10.3171/ped.2005.103.1.0050.
The failure rate following endoscopic third ventriculostomy (ETV) in infants younger than 1 year of age has been reported to be higher compared with that of older children. The authors present results of ETVs in such infants and advocate that success or failure of the procedure depends not on the age of the patient but on the cause of the hydrocephalus.
The authors retrospectively reviewed the management and outcome of 18 ETVs in infants for the treatment of hydrocephalus. The surgeries were performed between November 1996 and October 2002. The mean age at the time of surgery was 150 days (range 9-354 days). The minimal follow-up period was 18 months and the mean was 50 months. The authors divided the patients into the following three groups: obstructive hydrocephalus (four infants), communicating hydrocephalus (10 infants), and hydrocephalus associated with myelomeningocele (four infants). No perioperative death occurred, and perioperative transient morbidity related to ETV was low. The success of the procedure was determined by the cause of the hydrocephalus. Infants with obstructive hydrocephalus had a 100% success rate (four of four), and infants with communicating hydrocephalus had a 10% success rate (one of 10). In infants with hydrocephalus related to myelomeningocele, the success rate was 50% (two of four).
The authors conclude that ETV presents an effective alternative for the treatment of obstructive hydrocephalus in infants younger than 1 year of age. Age does not present a contraindication for ETV, nor does it increase the perioperative risk. The success of ETV is determined by the cause of the hydrocephalus.
据报道，1岁以下婴儿接受内镜下第三脑室造瘘术（ETV）后的失败率高于大龄儿童。作者展示了此类婴儿接受ETV的结果，并主张该手术的成功或失败不取决于患者年龄，而是取决于脑积水的病因。
作者回顾性分析了18例婴儿ETV治疗脑积水的管理及结果。手术于1996年11月至2002年10月期间进行。手术时的平均年龄为150天（范围9 - 354天）。最短随访期为18个月，平均为50个月。作者将患者分为以下三组：梗阻性脑积水（4例婴儿）、交通性脑积水（10例婴儿）和与脊髓脊膜膨出相关的脑积水（4例婴儿）。围手术期无死亡发生，与ETV相关的围手术期短暂性并发症发生率较低。手术的成功取决于脑积水的病因。梗阻性脑积水婴儿的成功率为100%（4例中的4例），交通性脑积水婴儿的成功率为10%（10例中的1例）。与脊髓脊膜膨出相关的脑积水婴儿的成功率为50%（4例中的2例）。
作者得出结论，ETV是治疗1岁以下婴儿梗阻性脑积水的有效替代方法。年龄并非ETV的禁忌证，也不会增加围手术期风险。ETV的成功取决于脑积水的病因。
