Xu Ran, McCrea Heather J, Hoffman Caitlin E, Souweidane Mark M, Greenfield Jeffrey P
Department of Neurological Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
Department of Neurological Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA; Department of Neurosurgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York, USA.
World Neurosurg. 2015 Sep;84(3):677-680.e1. doi: 10.1016/j.wneu.2015.04.037. Epub 2015 Apr 28.
Shunt-related procedures in the treatment of hydrocephalus are often associated with malfunction and revision resulting in significant patient morbidity and financial impact on the health care system. The increased utilization of endoscopic third ventriculostomy (ETV) as an alternative treatment paradigm for obstructive hydrocephalus carries the theoretical expectation of concomitant decreased numbers of shunt procedures. The objective of the present study was to determine the impact of ETV on shunt-related procedures within a 14-year interval (1998-2011), during which ETV has gained wider acceptance and greater utilization.
This retrospective chart review describes the annual rate of pediatric patients who underwent either ETV or shunt-related procedures at New York Presbyterian Hospital Weill-Cornell Medical Center. Statistical analyses were done to analyze possible correlation between relative rates of these cases.
During the 14-year study period, 954 procedures were performed for the treatment of hydrocephalus (159 ETVs and 795 shunt-related procedures). Of the shunts, 356 were initial insertions and 439 were revisions. The number of ETVs increased from 8 procedures in 1998/1999 to 34 in 2010/2011, whereas the total number of annual shunt-related procedures decreased from 146 to 99. The relative ratios of ETVs and shunt-related procedures to the total number of cases demonstrate an inverse relationship over time (Spearman correlation coefficient rs = -1.0; P = 0.0004).
Based on prior cost-effectiveness analyses, the observed trend of the inverse correlation between ETVs and shunt-related procedures may contribute to financial savings and improvement in patient outcomes. Further study is required to define the impact on morbidity and associated success rates.
脑积水治疗中与分流相关的手术常伴有功能障碍和翻修情况，导致患者出现严重并发症，并对医疗保健系统造成经济影响。作为梗阻性脑积水的一种替代治疗模式，内镜下第三脑室造瘘术（ETV）应用的增加，理论上预期会使分流手术的数量相应减少。本研究的目的是确定在14年期间（1998 - 2011年）ETV对与分流相关手术的影响，在此期间ETV已获得更广泛的认可和更高的使用率。
这项回顾性病历审查描述了纽约长老会医院威尔·康奈尔医学中心接受ETV或与分流相关手术的儿科患者的年发生率。进行统计分析以分析这些病例相对发生率之间的可能相关性。
在14年的研究期间，共进行了954例脑积水治疗手术（159例ETV和795例与分流相关的手术）。在分流手术中，356例为初次植入，439例为翻修。ETV的数量从1998/1999年的8例增加到2010/2011年的34例，而每年与分流相关手术的总数从146例减少到99例。ETV和与分流相关手术占病例总数的相对比例随时间呈反比关系（Spearman相关系数rs = -1.0；P = 0.0004）。
基于先前的成本效益分析，ETV与分流相关手术之间观察到的反比趋势可能有助于节省费用并改善患者预后。需要进一步研究以确定对并发症发生率和相关成功率的影响。
