Kombogiorgas D, Sgouros S
Department of Neurosurgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
Childs Nerv Syst. 2006 Oct;22(10):1256-62. doi: 10.1007/s00381-006-0072-0. Epub 2006 Mar 29.
To determine if operative factors correlate with success of endoscopic third ventriculostomy (ETV) in the treatment of hydrocephalus.
The ETV procedure video of 33 hydrocephalic children was reviewed. Mean age at operation was 76 months (range: 1-196). Success was defined as no need for shunt in the long term. We calculated the relative size of stoma as the percentage of stoma diameter to the distance between posterior clinoid-basilar artery. Factors analysed were: intra-operative haemorrhage, stoma size, thick/double third ventricular floor, pre-pontine adhesions presence, brisk cerebro-spinal fluid (CSF) flow through the stoma as well as hydrocephalus cause, previous shunt presence, CSF infection or haemorrhage and previous ETV. Analysis was performed using chi-square, linear regression, and one-way ANOVA.
Overall ETV success rate was 42%. Mean stoma size was 37%. For the entire group, none of the operative factors correlated statistically with success. Previous shunt presence adversely correlated with success (p=0.008). The highest success rate was in the aqueduct stenosis group. In patients without previous shunt (n=17), stoma size over 30% tended towards significance (p=0.094), CSF leak was adversely associated with ETV success (p=0.041) and mean stoma size was 41.3% in successful ETV and 27.8% in unsuccessful ETV (p=0.072). In patients with previous shunt (n=16), thin third ventricular floor was a negative predisposing factor (p=0.057).
This study did not demonstrate a correlation between the presence of pre-pontine adhesions, double or thickened floor of third ventricle and ETV success. In patients without previous shunt, stoma size may correlate with success. CSF leak was strongly associated with failure.
确定手术因素是否与内镜下第三脑室造瘘术(ETV)治疗脑积水的成功率相关。
回顾了33例脑积水患儿的ETV手术视频。手术时的平均年龄为76个月(范围:1 - 196个月)。成功定义为长期无需分流。我们将造瘘口的相对大小计算为造瘘口直径占后床突 - 基底动脉间距的百分比。分析的因素包括:术中出血、造瘘口大小、第三脑室底部增厚/双层、脑桥前粘连的存在、脑脊液(CSF)通过造瘘口的快速流动以及脑积水病因、既往是否有分流、CSF感染或出血以及既往是否行ETV。使用卡方检验、线性回归和单因素方差分析进行分析。
ETV总体成功率为42%。平均造瘘口大小为37%。对于整个组,没有手术因素与成功率有统计学相关性。既往有分流与成功率呈负相关(p = 0.008)。导水管狭窄组的成功率最高。在既往无分流的患者(n = 17)中,造瘘口大小超过30%有趋于显著的倾向(p = 0.094),脑脊液漏与ETV成功呈负相关(p = 0.041),成功的ETV中平均造瘘口大小为41.3%,失败的ETV中为27.8%(p = 0.072)。在既往有分流的患者(n = 16)中,第三脑室底部薄是一个负面的易感因素(p = 0.057)。
本研究未证明脑桥前粘连、第三脑室底部双层或增厚与ETV成功之间存在相关性。在既往无分流的患者中,造瘘口大小可能与成功相关。脑脊液漏与失败密切相关。