Riva-Cambrin Jay, Detsky Allan S, Lamberti-Pasculli Maria, Sargent Michael A, Armstrong Derek, Moineddin Rahim, Cochrane D Douglas, Drake James M
Department of Neurosurgery, Primary Children's Medical Center, University of Utah, Salt Lake City, Utah 84113, USA.
J Neurosurg Pediatr. 2009 May;3(5):378-85. doi: 10.3171/2009.1.PEDS08298.
Approximately 30% of children with posterior fossa tumors exhibit hydrocephalus after tumor resection. Recent literature has suggested that prophylactic endoscopic third ventriculostomy diminishes the risk of this event. Because the majority of patients will not have postoperative hydrocephalus, a preoperative clinical prediction rule that identifies patients at high or low risk for postresection hydrocephalus would be helpful to optimize the care of these children.
The authors evaluated a derivation cohort of 343 consecutive children with posterior fossa tumors who underwent treatment between 1989 and 2003. Multivariate methods were used on these data to generate the Canadian Preoperative Prediction Rule for Hydrocephalus. The rule's estimated risk of postresection hydrocephalus was compared with risk observed in 111 independent patients in the validation cohort.
Variables identified as significant in predicting postresection hydrocephalus were age < 2 years (score of 3), papilledema (score of 1), moderate to severe hydrocephalus (score of 2), cerebral metastases (score of 3), and specific estimated tumor pathologies (score of 1). Patients with scores > or = 5 were deemed as high risk. Predicted probabilities for the high- and low-risk groups were 0.73 and 0.25, respectively, from the derivation cohort, and 0.59 and 0.14 after prevalence adjustment compared with the observed values of 0.42 and 0.17 in the validation cohort.
A patient's score on the Preoperative Prediction Rule for Hydrocephalus will allow improved patient counseling and surgical planning by identifying patients at high risk of developing postresection hydrocephalus. These patients might selectively be exposed to the risks of preresection CSF diversion to improve outcome.
后颅窝肿瘤患儿在肿瘤切除术后约30%会出现脑积水。近期文献表明，预防性内镜下第三脑室造瘘可降低发生这种情况的风险。由于大多数患者术后不会出现脑积水，因此术前临床预测规则若能识别出切除术后发生脑积水的高风险或低风险患者，将有助于优化对这些患儿的治疗。
作者评估了1989年至2003年间接受治疗的343例连续的后颅窝肿瘤患儿的推导队列。对这些数据采用多变量方法生成加拿大术前脑积水预测规则。将该规则估计的切除术后脑积水风险与验证队列中111例独立患者观察到的风险进行比较。
在预测切除术后脑积水方面被确定为有显著意义的变量包括：年龄<2岁（得分为3）、视乳头水肿（得分为1）、中度至重度脑积水（得分为2）、脑转移（得分为3）以及特定的估计肿瘤病理类型（得分为1）。得分≥5分的患者被视为高风险。推导队列中高风险和低风险组的预测概率分别为0.73和0.25，经患病率调整后分别为0.59和0.14，而验证队列中的观察值分别为0.42和0.17。
患者的脑积水术前预测规则得分将有助于更好地为患者提供咨询并进行手术规划，通过识别切除术后发生脑积水的高风险患者。这些患者可能会有选择地面临切除术前脑脊液分流的风险，以改善治疗结果。
