Dusick Joshua R, McArthur David L, Bergsneider Marvin
Division of Neurosurgery, University of California at Los Angeles David Geffen School of Medicine, UCLA Medical Center, Los Angeles, CA 90095-6901, USA.
Surg Neurol. 2008 Jan;69(1):5-15. doi: 10.1016/j.surneu.2007.08.024.
The clinical response to ETV of adult patients with noncommunicating hydrocephalus may differ from that of children because of such factors as chronicity of hydrocephalus, physiologic differences in CSF dynamics, and changes in brain viscoelastic properties. We sought to determine which factors might predict clinical success and failure.
A retrospective single-surgeon case series analysis was performed. This was a consecutive case series for which the goal of the ETV procedures was shunt independence. One hundred ten ETV procedures were performed in 108 adult patients (mean, 48 years; range, 17-88 years). There were 52 cases of idiopathic aqueductal stenosis, 47 cases of mass lesions causing noncommunicating hydrocephalus, plus 9 other miscellaneous obstructive etiologies.
Long-term shunt independence was achieved in 77% of patients. Two additional patients, who initially failed, later achieved success after reoperation and remained shunt free for the duration of their follow-up. Therefore, after reoperation, shunt independence was achieved in 79% of patients. Of the patients who ultimately failed, 11 failed within 1 month. Therefore, 52% who ultimately failed had more than 1 month of shunt-free existence (mean, 10 months). There were 6 surgical complications, including 2 deaths related to intracranial hemorrhage from brain tumors (not directly related to ETV per se), and 10 medical complications. The median hospital length-of-stay was 3 days. The median follow-up was 8 months (range, 0-95 months).
Endoscopic third ventriculostomy is an effective treatment option for adult patients with noncommunicating hydrocephalus. Although most procedures resulted in long-term shunt independence, more than half of the eventual failures were delayed, and therefore, appropriate follow-up is required.
由于脑积水的慢性病程、脑脊液动力学的生理差异以及脑粘弹性特性的变化等因素，成年非交通性脑积水患者对内镜下第三脑室造瘘术（ETV）的临床反应可能与儿童不同。我们试图确定哪些因素可能预测临床成功与失败。
进行了一项回顾性单术者病例系列分析。这是一个连续的病例系列，ETV手术的目标是实现分流独立。对108例成年患者（平均48岁；范围17 - 88岁）进行了110次ETV手术。其中特发性导水管狭窄52例，因占位性病变导致非交通性脑积水47例，另有9例其他杂类梗阻病因。
77%的患者实现了长期分流独立。另外两名最初手术失败的患者，在再次手术后获得成功，且在随访期间一直无需分流。因此，再次手术后，79%的患者实现了分流独立。在最终失败的患者中，11例在1个月内失败。因此，最终失败的患者中有52%有超过1个月的无分流生存期（平均10个月）。有6例手术并发症，包括2例因脑肿瘤颅内出血导致的死亡（与ETV本身无直接关系），以及10例医疗并发症。中位住院时间为3天。中位随访时间为8个月（范围0 - 95个月）。
内镜下第三脑室造瘘术是成年非交通性脑积水患者的一种有效治疗选择。尽管大多数手术导致了长期分流独立，但超过一半的最终失败者是延迟失败，因此需要进行适当的随访。
