Naftel Robert P, Reed Gavin T, Kulkarni Abhaya V, Wellons John C
Section of Pediatric Neurosurgery, Division of Neurosurgery, University of Alabama, Children's Hospital, Birmingham, Alabama, USA.
J Neurosurg Pediatr. 2011 Nov;8(5):494-501. doi: 10.3171/2011.8.PEDS1145.
Endoscopic third ventriculostomy (ETV) success is dependent on patient characteristics including age, origin of hydrocephalus, and history of shunt therapy. Using these factors, an Endoscopic Third Ventriculostomy Success Score (ETVSS) model was constructed to predict success of therapy. This study reports a single-institution experience with ETV and explores the ETVSS model validity.
A retrospective chart review identified 151 consecutive patients who underwent ETV at a pediatric hospital between August 1995 and December 2009. Of these 151, 136 patients had at least 6 months of clinical follow-up. Data concerning patient characteristics, operative characteristics, radiological findings, complications, and success of ETV were collected. The actual success rates were compared with those predicted by the ETVSS model.
The actual success rate of ETV at 6 months was 68.4% (93 of 136 patients), which compared well to the predicted ETVSS of 76.5% ± 12.5% (± SD). The C-statistic was 0.74 (95% CI 0.65-0.83), suggesting that the ability of the ETVSS to discriminate failures from successes was good. Secondary ETV was found to have a hazard ratio for failure of 4.2 (95% CI 2.4-7.2) compared with primary ETV (p < 0.001). The complication rate was 9.3% with no deaths. At the first radiological follow-up, the increased size of ventricles had a hazard ratio for failure of 3.0 (95% CI 1.5-6.0) compared with patients in whom ventricle size either remained stable or decreased (p = 0.002).
The ETVSS closely predicts the actual success of ETV, fitting the statistical model well. Shortcomings of the model were identified in overestimating success in patients with ETVSS ≤ 70, which may be attributable to the poor success of secondary ETVs in the authors' patient population.
内镜下第三脑室造瘘术（ETV）的成功取决于患者特征，包括年龄、脑积水病因及分流治疗史。利用这些因素构建了内镜下第三脑室造瘘术成功评分（ETVSS）模型以预测治疗成功率。本研究报告了一家机构开展ETV的经验并探讨ETVSS模型的有效性。
通过回顾性病历审查，确定了1995年8月至2009年12月期间在一家儿科医院连续接受ETV的151例患者。其中136例患者有至少6个月的临床随访。收集了有关患者特征、手术特征、影像学检查结果、并发症及ETV成功率的数据。将实际成功率与ETVSS模型预测的成功率进行比较。
ETV术后6个月的实际成功率为68.4%（136例患者中的93例），与预测的ETVSS 76.5%±12.5%（±标准差）相比情况良好。C统计量为0.74（95%可信区间0.65 - 0.83），表明ETVSS区分失败与成功的能力良好。与初次ETV相比，二次ETV失败的风险比为4.2（95%可信区间2.4 - 7.2）（p < 0.001）。并发症发生率为9.3%，无死亡病例。在首次影像学随访时，与脑室大小保持稳定或缩小的患者相比，脑室增大的患者失败的风险比为3.0（95%可信区间1.5 - 6.0）（p = 0.002）。
ETVSS能紧密预测ETV的实际成功率，与统计模型拟合良好。该模型的缺点是在ETVSS≤70的患者中高估了成功率，这可能归因于作者所治疗患者群体中二次ETV成功率较低。
