Erşahin Yusuf, Arslan Dilek
Division of Pediatric Neurosurgery, Ege University Faculty of Medicine, Izmir, Turkey.
Childs Nerv Syst. 2008 Aug;24(8):943-8. doi: 10.1007/s00381-008-0589-5. Epub 2008 Mar 4.
Although endoscopic third ventriculostomy (ETV) is considered as the first choice in the management of noncommunicating hydrocephalus, it is not without risk or complication.
The patients who had undergone ETV only between 1998 and 2005 were retrospectively reviewed. There were 85 males and 70 females, and 173 ETVs were performed in 155 patients. The patients' age ranged from 2 months to 77 years. Complications were categorized as (1) intraoperative, (2) early postoperative (<1 month), and (3) late postoperative (>1 month). Follow-up of the patients ranged from 1 to 86 months.
Overall complication rate per patient was 15.4%, and complication per procedure was 18%. Complication rate significantly varied with the etiology of hydrocephalus (P = 0.013). The patients with Chiari type I malformation and tumor had no or very low complication rates. The complication risk was significantly higher in repeat endoscopic procedure (55.5%) than in the first procedure (10%; P = 0.0001).
ETV should be the first choice in the management of noncommunicating hydrocephalus. Training, experience, and meticulous technique will decrease the complication rate. Patients undergoing ETV should be followed in a similar manner to patients with cerebrospinal fluid shunts.
尽管内镜下第三脑室造瘘术（ETV）被认为是治疗非交通性脑积水的首选方法，但它并非没有风险或并发症。
对1998年至2005年间仅接受ETV治疗的患者进行回顾性研究。其中男性85例，女性70例，155例患者共进行了173次ETV手术。患者年龄从2个月至77岁不等。并发症分为（1）术中并发症，（2）术后早期（<1个月）并发症，以及（3）术后晚期（>1个月）并发症。对患者的随访时间为1至86个月。
每位患者的总体并发症发生率为15.4%，每次手术的并发症发生率为18%。并发症发生率因脑积水病因的不同而有显著差异（P = 0.013）。患有Chiari I型畸形和肿瘤的患者并发症发生率很低或无并发症。再次内镜手术的并发症风险（55.5%）显著高于首次手术（10%；P = 0.0001）。
ETV应作为治疗非交通性脑积水的首选方法。培训、经验以及细致的操作技术将降低并发症发生率。接受ETV治疗的患者应采用与脑脊液分流患者类似的方式进行随访。
