Beuriat Pierre-Aurelien, Puget Stephanie, Cinalli Giuseppe, Blauwblomme Thomas, Beccaria Kevin, Zerah Michel, Sainte-Rose Christian
Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Lyon Cedex.
Department of Pediatric Neurosurgery, Hôpital Necker-Enfants Malades, Paris, France ; and.
J Neurosurg Pediatr. 2017 Jul;20(1):10-18. doi: 10.3171/2017.2.PEDS16491. Epub 2017 Apr 21.
OBJECTIVE Hydrocephalus remains one of the more common pathologies managed in pediatric neurosurgical units. Endoscopic third ventriculostomy (ETV) has an advantage over ventriculoperitoneal shunting as it enables patients to remain device free. Multiple shunt devices with various valve designs exist, with no one valve proven to be superior to another. The aim of this study was to describe the management of hydrocephalus and its long-term outcome. METHODS The authors retrospectively reviewed the medical records of all patients who had been treated for hydrocephalus at the Hôpital Necker-Enfants Malades in the period from 1985 to 1995. RESULTS Nine hundred seventy-five children had been treated for hydrocephalus. The mean follow-up was 11 ± 7.4 years (mean ± standard deviation). The most common cause of hydrocephalus was tumor related (32.3%), followed by malformative (24.5%) and inflammatory (20.9%) causes. Two hundred eighty patients underwent ETV as the first-line treatment. The procedure was effective in controlling hydrocephalus due to posterior fossa tumors and aqueductal stenosis. Six hundred ninety-five children had initial shunt insertion, with the majority receiving an Orbis-Sigma valve (OSV). The overall OSV shunt survival was 70% at 1 year, 58% at 10 years, and 49% at 20 years. The most common cause for mechanical shunt failure was obstruction (50.7%). Overall shunt survival was statistically different between the OSV and the differential-pressure valve (p = 0.009). CONCLUSIONS Endoscopic third ventriculostomy is effective in the management of childhood hydrocephalus. Its success is directly related to the underlying pathology. In the long term, the OSV has significantly higher event-free shunt survival than the classic differential-pressure valve systems.
目的 脑积水仍然是儿科神经外科病房中较为常见的病症之一。内镜下第三脑室造瘘术（ETV）相较于脑室腹腔分流术具有优势，因为它能使患者无需依赖分流装置。现存在多种带有不同瓣膜设计的分流装置，但尚无一种瓣膜被证明优于其他瓣膜。本研究的目的是描述脑积水的治疗方法及其长期预后。方法 作者回顾性分析了1985年至1995年期间在巴黎内克尔儿童医院接受脑积水治疗的所有患者的病历。结果 共有975名儿童接受了脑积水治疗。平均随访时间为11±7.4年（平均值±标准差）。脑积水最常见的病因是肿瘤相关（32.3%），其次是畸形（24.5%）和炎症（20.9%）。280例患者接受ETV作为一线治疗。该手术对于控制后颅窝肿瘤和导水管狭窄所致的脑积水有效。695名儿童最初接受了分流管植入，大多数使用的是奥比斯-西格玛瓣膜（OSV）。OSV分流管1年时的总体生存率为70%，10年时为58%，20年时为49%。机械性分流管故障最常见的原因是堵塞（50.7%）。OSV和压差瓣膜的总体分流管生存率在统计学上存在差异（p = 0.009）。结论 内镜下第三脑室造瘘术在儿童脑积水的治疗中有效。其成功率与潜在病理状况直接相关。从长期来看，OSV的无事件分流管生存率显著高于传统的压差瓣膜系统。
