Gianaris Thomas J, Nazar Ryan, Middlebrook Emily, Gonda David D, Jea Andrew, Fulkerson Daniel H
Department of Neurological Surgery, Division of Pediatric Neurosurgery, Goodman Campbell Brain and Spine, Indiana University School of Medicine, Indianapolis, Indiana.
Department of Neurosurgery, University of Louisville, Kentucky.
J Neurosurg Pediatr. 2017 Sep;20(3):225-231. doi: 10.3171/2016.7.PEDS1655. Epub 2017 Jul 7.
OBJECTIVE Endoscopic third ventriculostomy (ETV) is a surgical alternative to placing a CSF shunt in certain patients with hydrocephalus. The ETV Success Score (ETVSS) is a reliable, simple method to estimate the success of the procedure by 6 months of postoperative follow-up. The highest score is 90, estimating a 90% chance of the ETV effectively treating hydrocephalus without requiring a shunt. Treatment with ETV fails in certain patients, despite their being the theoretically best candidates for the procedure. In this study the authors attempted to identify factors that further predicted success in patients with the highest ETVSSs. METHODS A retrospective review was performed of all patients treated with ETV at 3 institutions. Demographic, radiological, and clinical data were recorded. All patients by definition were older than 1 year, had obstructive hydrocephalus, and did not have a prior shunt. Failure of ETV was defined as the need for a shunt by 1 year. The ETV was considered a success if the patient did not require another surgery (either shunt placement or a repeat endoscopic procedure) by 1 year. A statistical analysis was performed to identify factors associated with success or failure. RESULTS Fifty-nine patients met the entry criteria for the study. Eleven patients (18.6%) required further surgery by 1 year. All of these patients received a shunt. The presenting symptom of lethargy statistically correlated with success (p = 0.0126, odds ratio [OR] = 0.072). The preoperative radiological finding of transependymal flow (p = 0.0375, OR 0.158) correlated with success. A postoperative larger maximum width of the third ventricle correlated with failure (p = 0.0265). CONCLUSIONS The preoperative findings of lethargy and transependymal flow statistically correlated with success. This suggests that the best candidates for ETV are those with a relatively acute elevation of intracranial pressure. Cases without these findings may represent the failures in this highly selected group.
目的 内镜下第三脑室造瘘术（ETV）是某些脑积水患者放置脑脊液分流管的一种手术替代方法。ETV成功评分（ETVSS）是一种可靠、简单的方法，可通过术后6个月的随访来评估该手术的成功率。最高分为90分，估计ETV有效治疗脑积水而无需分流管的概率为90%。尽管某些患者在理论上是该手术的最佳候选者，但ETV治疗仍会失败。在本研究中，作者试图确定在ETVSS最高的患者中进一步预测成功的因素。方法 对3家机构接受ETV治疗的所有患者进行回顾性研究。记录人口统计学、放射学和临床数据。根据定义，所有患者年龄均超过1岁，患有梗阻性脑积水，且此前未行分流术。ETV失败定义为1年内需要放置分流管。如果患者1年内不需要再次手术（无论是放置分流管还是重复内镜手术），则认为ETV成功。进行统计分析以确定与成功或失败相关的因素。结果 59例患者符合研究纳入标准。11例患者（18.6%）在1年内需要进一步手术。所有这些患者均接受了分流管置入。嗜睡这一就诊症状与成功具有统计学相关性（p = 0.0126，比值比[OR] = 0.072）。术前经室管膜下流动的放射学表现与成功相关（p = 0.0375，OR 0.158）。术后第三脑室最大宽度较大与失败相关（p = 0.0265）。结论 术前嗜睡和经室管膜下流动的表现与成功具有统计学相关性。这表明ETV的最佳候选者是那些颅内压相对急性升高的患者。没有这些表现的病例可能代表了这一高度选择人群中的失败案例。
