Bisht Ajay, Suri Ashish, Bansal Sumit, Chandra P Sarat, Kumar Rajinder, Singh Manmohan, Sharma Bhawani Shankar
Department of Neurosurgery, Neurosciences Center, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
Department of Neurosurgery, Neurosciences Center, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
J Clin Neurosci. 2014 Sep;21(9):1483-9. doi: 10.1016/j.jocn.2013.12.033. Epub 2014 Jun 9.
Endoscopic third ventriculostomy (ETV) is an accepted modality of treatment for obstructive hydrocephalus, with good results in adult patients. However in the pediatric age group results vary from poor to similar to the adult population. This study evaluates the outcome of ETV in congenital hydrocephalus of both early and delayed presentation, and investigates factors that determine the outcome. Patients with congenital hydrocephalus who underwent ETV between January 2006 and December 2011 were retrospectively analyzed. Any conditions potentially influencing the need for redo surgery (persistent cerebrospinal fluid [CSF] leak not responding to local measures, tense fontanelle, increased ventricular size, recurrence of symptoms or radiological evidence of failure) were analyzed. A total of 102 patients with a mean age of 7.45years were included. Presenting features were increasing head circumference and delayed milestones. Ninety-eight patients had triventricular hydrocephalus due to aqueductal stenosis. Procedures performed were ETV only (n=74), ETV with aqueductoplasty (n=22), ETV with cystoventriculostomy (n=2) and aqueductoplasty only (n=2). Failure of ETV occurred in 11 patients and all were managed with a ventriculoperitoneal shunt. CSF leak in the perioperative period was the only factor that was significantly associated with failure of ETV. ETV is a safe procedure with a good success rate and can be offered to children with aqueductal stenosis. There is a higher chance of failure if there is a CSF leak in the early or late postoperative period.
内镜下第三脑室造瘘术（ETV）是治疗梗阻性脑积水的一种公认方法，在成年患者中效果良好。然而，在儿童年龄组中，其结果差异较大，从较差到与成年人群相似不等。本研究评估了早期和延迟就诊的先天性脑积水患者行ETV的结果，并调查了决定结果的因素。对2006年1月至2011年12月期间接受ETV的先天性脑积水患者进行回顾性分析。分析了任何可能影响再次手术需求的情况（对局部措施无反应的持续性脑脊液[CSF]漏、囟门紧张、脑室增大、症状复发或失败的影像学证据）。共纳入102例平均年龄为7.45岁的患者。主要表现为头围增大和发育迟缓。98例患者因导水管狭窄导致三脑室脑积水。所进行的手术包括单纯ETV（n = 74）、ETV联合导水管成形术（n = 22）、ETV联合囊肿脑室造瘘术（n = 2）和单纯导水管成形术（n = 2）。11例患者ETV失败，均接受了脑室腹腔分流术治疗。围手术期脑脊液漏是与ETV失败显著相关的唯一因素。ETV是一种安全的手术，成功率较高，可用于治疗导水管狭窄的儿童。如果术后早期或晚期出现脑脊液漏，失败的可能性较高。
