Kulkarni Abhaya V, Shams Iffat, Cochrane D Douglas, McNeely P Daniel
Division of Neurosurgery, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, Canada , M5G 1X8.
Childs Nerv Syst. 2010 Nov;26(11):1529-34. doi: 10.1007/s00381-010-1162-6. Epub 2010 Apr 29.
A possible benefit of endoscopic third ventriculostomy (ETV) is that families might harbor less concern and anxiety compared to shunt. This has not yet been demonstrated, however. Our goal was to compare parental concern in a large sample of children with hydrocephalus treated with ETV or shunt, using our previously developed measure of parental concern, the Hydrocephalus Concerns Questionnaire for Parents (HCQ-P).
The parents of children 5-18 years old with previously treated hydrocephalus at three Canadian pediatric neurosurgery centers completed the HCQ-P. HCQ-P scores were compared between those who were initially treated with ETV and those initially treated with shunt. A multivariable linear regression analysis was used to adjust for center, current age, age at initial hydrocephalus surgery, seizures, etiology, hydrocephalus complications, and quality of life.
Six hundred three families participated (58 ETV [9.6%], 545 shunt [90.4%]). In unadjusted comparison, ETV parents had lower overall concern (HCQ-P = 0.41 versus 0.51, p = 0.02). After adjustment for multiple patient factors, ETV parents still had lower concern (p = 0.03) but the only questions for which there was a still a statistically significant difference were those related to concerns about shunt/ETV complications.
Parents of children who have had ETV experience less concern than those who have had shunt and this is due almost exclusively to less concern about hydrocephalus treatment complications. While this could be interpreted as a beneficial aspect of ETV treatment, it remains important for neurosurgeons to ensure that parents are not being overly complacent about the possibility of ETV failure requiring urgent treatment.
内镜下第三脑室造瘘术（ETV）的一个潜在益处可能是，与分流术相比，患儿家庭的担忧和焦虑可能更少。然而，这一点尚未得到证实。我们的目标是使用我们之前开发的家长担忧程度测量工具——《脑积水家长担忧问卷》（HCQ-P），比较接受ETV或分流术治疗的大量脑积水患儿家长的担忧程度。
加拿大三个儿科神经外科中心5至18岁曾接受脑积水治疗的患儿家长完成了HCQ-P问卷。比较最初接受ETV治疗的家长和最初接受分流术治疗的家长的HCQ-P得分。采用多变量线性回归分析来调整中心、当前年龄、初次脑积水手术时的年龄、癫痫、病因、脑积水并发症和生活质量等因素。
603个家庭参与研究（58例接受ETV治疗[9.6%]，545例接受分流术治疗[90.4%]）。在未调整的比较中，接受ETV治疗患儿的家长总体担忧程度较低（HCQ-P=0.41对0.51，p=0.02）。在对多个患者因素进行调整后，接受ETV治疗患儿的家长担忧程度仍然较低（p=0.03），但仍存在统计学显著差异的唯一问题是与分流术/ETV并发症担忧相关的问题。
接受ETV治疗的患儿家长比接受分流术治疗的患儿家长担忧更少，这几乎完全是因为对脑积水治疗并发症的担忧较少。虽然这可以被解释为ETV治疗的一个有益方面，但神经外科医生仍需确保家长不会对ETV失败需要紧急治疗的可能性过于自满，这一点很重要。
