Stovell Matthew G, Zakaria Rasheed, Ellenbogen Jonathan R, Gallagher Mathew J, Jenkinson Michael D, Hayhurst Caroline, Mallucci Conor L
Department of Neurosurgery, Royal Liverpool Children's Hospital;
Department of Neurosurgery, The Walton Centre for Neurology and Neurosurgery, Liverpool; and.
J Neurosurg Pediatr. 2016 Jun;17(6):734-8. doi: 10.3171/2015.11.PEDS15212. Epub 2016 Feb 12.
OBJECTIVE Endoscopic third ventriculostomy (ETV) is an effective treatment for obstructive hydrocephalus and avoids the risk for foreign-body infection associated with ventriculoperitoneal (VP) shunts. The short-term failure rate of ETV strongly depends on the indications for its use but is generally thought to be lower in the long term than that of VP shunts. However, few studies are available with long-term follow-up data of ETV for hydrocephalus in children. The authors reviewed the long-term success of ETV at their institution to investigate the rate of any late failures of this procedure. METHODS Between April 1998 and June 2006, 113 children (including neonates and children up to 16 years old) had primary or secondary ETV for different causes of hydrocephalus. The patients' medical records and the authors' electronic operation database were reviewed for evidence of additional surgery (i.e., repeat ETV or VP shunt insertion). These records were checked at both the pediatric and adult neurosurgical hospitals for those patients who had their care transferred to adult services. RESULTS The median length of follow-up was 8.25 years (range 1 month to 16 years). Long-term follow-up data for 96 patients were available, 47 (49%) of whom had additional ETV or VP shunt insertion for ETV failure. Twenty patients (21%) had a second procedure within 1 month, 17 patients (18%) between 1 and 12 months, 7 patients (7%) between 1 and 5 years, and 3 patients (3%) between 5 and 8 years. CONCLUSIONS In the authors' series, ETV had an initial early failure rate for the treatment of pediatric hydrocephalus as reported previously, and this rate significantly depended on patient age and hydrocephalus etiology. Once stabilized and effective, ETV appeared to be durable but not guaranteed, and some late decline in effectiveness was observed, with some ETV failures occurring many years later. Thus, successful ETV in children cannot be guaranteed for life, and some form of follow-up is recommended long term into adulthood.
目的 内镜下第三脑室造瘘术（ETV）是治疗梗阻性脑积水的一种有效方法，可避免与脑室腹腔（VP）分流术相关的异物感染风险。ETV的短期失败率很大程度上取决于其使用指征，但一般认为从长期来看低于VP分流术。然而，关于儿童脑积水ETV长期随访数据的研究很少。作者回顾了其所在机构ETV的长期成功率，以调查该手术的任何晚期失败率。
方法 在1998年4月至2006年6月期间，113名儿童（包括新生儿和16岁以下儿童）因不同原因的脑积水接受了初次或二次ETV手术。查阅患者的病历和作者的电子手术数据库，以寻找再次手术（即重复ETV或插入VP分流管）的证据。对于那些转至成人科室治疗的患者，在儿科和成人神经外科医院都对这些记录进行了检查。
结果 随访时间中位数为8.25年（范围1个月至16年）。96名患者有长期随访数据，其中47名（49%）因ETV失败接受了再次ETV或VP分流管插入手术。20名患者（21%）在1个月内进行了二次手术，17名患者（18%）在1至12个月之间，7名患者（7%）在1至5年之间，3名患者（3%）在5至8年之间。
结论 在作者的系列研究中，ETV治疗儿童脑积水的早期失败率如先前报道的那样，且该比率显著取决于患者年龄和脑积水病因。一旦病情稳定且有效，ETV似乎具有持久性但并非绝对，观察到一些后期有效性下降情况，一些ETV失败发生在多年后。因此，儿童ETV成功不能保证终身有效，建议长期随访至成年。
