Navarro Ramon, Gil-Parra Raul, Reitman Aaron J, Olavarria Greg, Grant John A, Tomita Tadanori
Department of Pediatric Neurosurgery, Hospital Sant Joan de Deu, Universitat de Barcelona, Barcelona, Spain.
Childs Nerv Syst. 2006 May;22(5):506-13. doi: 10.1007/s00381-005-0031-1. Epub 2006 Jan 11.
Endoscopic third ventriculostomy (ETV) is considered by many authors the initial surgical procedure of choice for the treatment of non-communicant hydrocephalus. However, this procedure has early and late complications that neurosurgeons must be aware of when performing it.
A retrospective study of infants and children treated with ETV at Children's Memorial Hospital (Chicago, IL) between 1993 and 2004 is presented. A total of 136 ETVs in 122 patients were performed with 8.8% early complication rate (hemorrhage, CSF leak, infection, diabetes insipidus, and seizures). There were no fatalities but one patient had severe neurological disturbances due to intracranial hemorrhage at the second ETV. We identified several significant factors that influence the late ETV failure rate: age under 12 months (p=0.012), cases performed early in our experience (p=0.009), patients with hydrocephalus without expansive lesions (p=0.026), patients that had an external ventricular drain (EVD) after ETV (p<0.005), and patients who developed early complications (p=0.035).
A careful patient selection and preoperative planning lead to better results of ETV. A higher early and late complication rate in children younger than 1-year-old were noted in our series. There is definitely a learning curve for this technique, and several technical considerations are helpful to avoid adverse events. Most of the early complications are transient, while potential devastating injuries can occur. Long-term follow-up is needed to identify delayed closure of the fenestration. Ventricular access devise is helpful for diagnostic and therapeutic purposes during the follow-up.
许多作者认为内镜下第三脑室造瘘术（ETV）是治疗非交通性脑积水的首选初始手术方法。然而，该手术存在早期和晚期并发症，神经外科医生在实施手术时必须对此有所了解。
本文对1993年至2004年期间在芝加哥伊利诺伊州儿童纪念医院接受ETV治疗的婴幼儿及儿童进行了回顾性研究。共对122例患者实施了136次ETV手术，早期并发症发生率为8.8%（包括出血、脑脊液漏、感染、尿崩症和癫痫发作）。无死亡病例，但有1例患者在第二次ETV手术后因颅内出血出现严重神经功能障碍。我们确定了几个影响ETV晚期失败率的重要因素：年龄小于12个月（p = 0.012）、在我们经验早期实施的病例（p = 0.009）、无扩张性病变的脑积水患者（p = 0.026）、ETV术后留置脑室外引流管（EVD）的患者（p < 0.005）以及发生早期并发症的患者（p = 0.035）。
仔细的患者选择和术前规划可使ETV取得更好的效果。我们的系列研究中发现1岁以下儿童的早期和晚期并发症发生率较高。这项技术肯定存在学习曲线，一些技术上的考虑有助于避免不良事件。大多数早期并发症是短暂的，但可能会发生潜在的毁灭性损伤。需要长期随访以确定造瘘口延迟闭合情况。脑室穿刺装置在随访期间有助于诊断和治疗。
