Warf Benjamin C, Campbell Jeffrey W
Division of Neurosurgery, Alfred I. duPont Hospital for Children, Wilmington, Delaware 19803, USA.
J Neurosurg Pediatr. 2008 Nov;2(5):310-6. doi: 10.3171/PED.2008.2.11.310.
Shunt dependence is more dangerous for children in less developed countries. Combining endoscopic third ventriculostomy (ETV) with choroid plexus cauterization (CPC) was previously shown to treat hydrocephalus more effectively than ETV alone in infants < 1 year of age. The goal of this prospective study was to evaluate the effectiveness of ETV-CPC as primary treatment of hydrocephalus in infants with myelomeningocele.
One hundred fifteen consecutive East African infants with myelomeningocele requiring treatment for hydrocephalus were intended for primary management using ETV-CPC. Patient information was prospectively entered into a database. Outcomes were evaluated by life table analysis. Potential predictors for treatment failure were evaluated using multivariate logistic regression.
Ninety-three patients had a completed ETV-CPC with > 1 month of follow-up. The ETV-CPC procedure was successful in 71 patients (76%), with a mean and median follow-up of 19.0 months. Treatment failures occurred before 6 months in 86% of the patients, and none occurred after 10 months. The operative mortality rate was 1.1%, and there were no infections. Life table analysis suggested that 72% of the patients would be successfully treated using a single ETV-CPC and 78% would remain shunt-independent with reopening of a closed ETV stoma. Multivariate logistic regression showed scarring of the cistern (p = 0.021) or choroid plexus (p = 0.026) as predictors of failure, but age at the time of surgery was not a significant predictor.
Using ETV-CPC appears to successfully provide a more durable primary treatment of hydrocephalus for infants with spina bifida than does shunt placement. These results support ETV-CPC as the better treatment option for these children in developing countries.
分流依赖对欠发达国家的儿童更为危险。先前研究表明，对于1岁以下婴儿，内镜下第三脑室造瘘术（ETV）联合脉络丛烧灼术（CPC）治疗脑积水比单纯ETV更有效。这项前瞻性研究的目的是评估ETV-CPC作为脊髓脊膜膨出婴儿脑积水主要治疗方法的有效性。
115例连续的东非脊髓脊膜膨出且需要治疗脑积水的婴儿拟采用ETV-CPC进行初始治疗。患者信息被前瞻性地录入数据库。通过生命表分析评估结果。使用多因素逻辑回归评估治疗失败的潜在预测因素。
93例患者完成了ETV-CPC且随访时间超过1个月。ETV-CPC手术在71例患者（76%）中成功，平均和中位随访时间为19.0个月。86%的患者在6个月前出现治疗失败，10个月后无治疗失败发生。手术死亡率为1.1%，无感染发生。生命表分析表明，72%的患者使用单次ETV-CPC可成功治疗，78%的患者在重新打开闭合的ETV造口后可保持无需分流。多因素逻辑回归显示，脑池（p = 0.021）或脉络丛（p = 0.026）瘢痕形成是失败的预测因素，但手术时的年龄不是显著预测因素。
与分流置入相比，使用ETV-CPC似乎能成功地为脊柱裂婴儿提供更持久的脑积水主要治疗方法。这些结果支持ETV-CPC作为发展中国家这些儿童更好的治疗选择。
