Foley R W, Ndoro S, Crimmins D, Caird J
a UCD School of Medicine and Medical Science , University College Dublin , Dublin , Ireland.
b Department of Paediatric Neurosurgery , Children's University Hospital , Temple Street , Dublin , Ireland.
Br J Neurosurg. 2017 Jun;31(3):314-319. doi: 10.1080/02688697.2016.1229744. Epub 2016 Sep 14.
The endoscopic third ventriculostomy success score (ETVSS) is a model, which provides each patient with a prediction of the outcome of endoscopic third ventriculostomy. The objective of this study was to determine if there is clinical value to the use of the ETVSS in the decision for ETV.
Prospectively collected data on all ETV procedures with the Republic of Ireland in children ≤16 years of age, totalling 112, from 2008 to 2014 was analysed. The percentage chance of success at six months was retrospectively calculated according to the ETVSS. A multivariable model, comprising the risk factors from the ETVSS - age, aetiology and previous shunt - was created and its performance compared to that of the ETVSS.
The ETVSS achieved an AUC of 0.61 (95% CI: 0.49-0.71) with a sensitivity and specificity of 50% and 76%, respectively, at its optimal cutoff. The ETVSS was not significantly well calibrated in this cohort and there was a limited net benefit on decision curve analysis in comparison with the strategy of performing ETV in all patients. The multivariable model achieved an AUC of 0.67 (95% CI: 0.56-0.78), was well calibrated and was associated with a superior net benefit over that of the ETVSS.
The ETVSS represents the future of patient risk stratification with an easy to use, individualised approach for each patient. The ETVSS has performed adequately in this study. However, through the addition of novel risk factors, the continuous updating of the model and recalibration where needed, the ETVSS can become a tool that the paediatric neurosurgeon cannot do without.
内镜下第三脑室造瘘术成功评分（ETVSS）是一种模型，可为每位患者预测内镜下第三脑室造瘘术的结果。本研究的目的是确定在决定是否进行内镜下第三脑室造瘘术时使用ETVSS是否具有临床价值。
分析了2008年至2014年在爱尔兰共和国对112例16岁及以下儿童进行的所有内镜下第三脑室造瘘术的前瞻性收集数据。根据ETVSS回顾性计算六个月时成功的百分比概率。创建了一个多变量模型，该模型包含ETVSS的风险因素——年龄、病因和既往分流情况，并将其性能与ETVSS进行比较。
ETVSS在最佳临界值时的曲线下面积（AUC）为0.61（95%可信区间：0.49 - 0.71），敏感性和特异性分别为50%和76%。在该队列中，ETVSS的校准效果不佳，与对所有患者进行内镜下第三脑室造瘘术的策略相比，决策曲线分析中的净效益有限。多变量模型的AUC为0.67（95%可信区间：0.56 - 0.78），校准良好，且与ETVSS相比具有更高的净效益。
ETVSS代表了患者风险分层的未来，采用易于使用的个体化方法针对每位患者进行评估。ETVSS在本研究中表现尚可。然而，通过添加新的风险因素、持续更新模型并在需要时重新校准，ETVSS可以成为小儿神经外科医生不可或缺的工具。
