Hader Walter J, Walker Robin L, Myles S Terence, Hamilton Mark
Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.
Neurosurgery. 2008 Jul;63(1 Suppl 1):ONS168-74; discussion ONS174-5. doi: 10.1227/01.neu.0000335032.31144.17.
Endoscopic third ventriculostomy (ETV) is considered to be a safe and effective treatment in selected patients as an initial treatment for obstructive hydrocephalus and at the time of shunt malfunction in previously shunted patients. We compared the outcome and complications of ETV between patients with newly diagnosed hydrocephalus and those with previous shunting procedures.
A retrospective review of patients undergoing ETV from 1996 to 2004 at Alberta's Childrens Hospital and Foothills Medical Centre was completed. Patient data included symptoms at clinical presentation, cause of hydrocephalus, age at initial shunt, number of previous shunt revisions, age at ETV, complications, and subsequent shunting procedures performed.
A total of 131 patients were identified with a minimum follow-up duration of 1 year; 71 (82.5%) of 86 patients who underwent ETV as a primary procedure and 36 (80%) of 45 patients who had ETV at the time of shunt malfunction were shunt-free at the last follow-up evaluation. Patients younger than 1 year old who underwent ETV were more likely to require an additional procedure for control of their hydrocephalus (P < 0.01). Serious complications after ETV occurred more frequently in patients who presented at the time of shunt malfunction (14 of 45 patients, 31%) compared with patients who underwent primary ETV (seven of 86 patients, 8%) (P = 0.02). Previously shunted patients with a history of two or more revisions (P = 0.03) and who experienced a serious complication at the time of ETV (P = 0.01) were more likely to require shunt replacement.
ETV is an effective treatment both in selected patients with newly diagnosed hydrocephalus and in patients with a previous shunting procedure who are presenting with malfunction. Complications of ETV occur more frequently in previously shunted patients than in patients treated for newly diagnosed hydrocephalus, and care must be taken in the selection and treatment of these patients.
对于部分患者，内镜下第三脑室造瘘术（ETV）被认为是治疗梗阻性脑积水的一种安全有效的初始治疗方法，也是治疗既往行分流术患者分流装置故障时的一种有效方法。我们比较了新诊断脑积水患者和既往有分流手术史患者行ETV后的疗效和并发症情况。
对1996年至2004年在艾伯塔省儿童医院和山麓医疗中心接受ETV治疗的患者进行回顾性研究。患者数据包括临床表现时的症状、脑积水病因、初次分流时的年龄、既往分流术修订次数、ETV时的年龄、并发症以及随后进行的分流手术情况。
共确定131例患者，最小随访时间为1年；86例行ETV作为初次手术的患者中有7I例（82.5%），45例在分流装置故障时行ETV的患者中有36例（80%）在最后一次随访评估时无需分流。1岁以下行ETV的患者更有可能需要额外的手术来控制脑积水（P<0.01）。与初次行ETV的患者（86例中的7例，8%）相比，分流装置故障时行ETV的患者（45例中的14例，31%）ETV后严重并发症的发生率更高（P = 0.02）。既往有两次或更多次分流术修订史（P = 0.03）以及ETV时发生严重并发症（P = 0.01）的既往分流患者更有可能需要更换分流装置。
ETV对于部分新诊断脑积水患者以及既往有分流手术史且出现分流装置故障的患者是一种有效的治疗方法。与新诊断脑积水患者相比，既往分流患者ETV并发症的发生率更高，因此在这些患者的选择和治疗中必须谨慎。
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