Breimer Gerben E, Dammers Ruben, Woerdeman Peter A, Buis Dennis R, Delye Hans, Brusse-Keizer Marjolein, Hoving Eelco W
Department of Neurosurgery, University Medical Center Groningen.
Departments of 2 Pathology and.
J Neurosurg Pediatr. 2017 Oct;20(4):314-323. doi: 10.3171/2017.4.PEDS16669. Epub 2017 Jul 14.
OBJECTIVE After endoscopic third ventriculostomy (ETV), some patients develop recurrent symptoms of hydrocephalus. The optimal treatment for these patients is not clear: repeat ETV (re-ETV) or CSF shunting. The goals of the study were to assess the effectiveness of re-ETV relative to initial ETV in pediatric patients and validate the ETV success score (ETVSS) for re-ETV. METHODS Retrospective data of 624 ETV and 93 re-ETV procedures were collected from 6 neurosurgical centers in the Netherlands (1998-2015). Multivariable Cox proportional hazards modeling was used to provide an adjusted estimate of the hazard ratio for re-ETV failure relative to ETV failure. The correlation coefficient between ETVSS and the chance of re-ETV success was calculated using Kendall's tau coefficient. Model discrimination was quantified using the c-statistic. The effects of intraoperative findings and management on re-ETV success were also analyzed. RESULTS The hazard ratio for re-ETV failure relative to ETV failure was 1.23 (95% CI 0.90-1.69; p = 0.20). At 6 months, the success rates for both ETV and re-ETV were 68%. ETVSS was significantly related to the chances of re-ETV success (τ = 0.37; 95% bias corrected and accelerated CI 0.21-0.52; p < 0.001). The c-statistic was 0.74 (95% CI 0.64-0.85). The presence of prepontine arachnoid membranes and use of an external ventricular drain (EVD) were negatively associated with treatment success, with ORs of 4.0 (95% CI 1.5-10.5) and 9.7 (95% CI 3.4-27.8), respectively. CONCLUSIONS Re-ETV seems to be as safe and effective as initial ETV. ETVSS adequately predicts the chance of successful re-ETV. The presence of prepontine arachnoid membranes and the use of EVD negatively influence the chance of success.
在内镜下第三脑室造瘘术（ETV）后，部分患者会出现脑积水复发症状。对于这些患者的最佳治疗方法尚不清楚：是重复ETV（re - ETV）还是脑脊液分流。本研究的目的是评估小儿患者中re - ETV相对于初始ETV的有效性，并验证re - ETV的ETV成功评分（ETVSS）。方法：从荷兰6个神经外科中心收集了624例ETV手术和93例re - ETV手术的回顾性数据（1998 - 2015年）。采用多变量Cox比例风险模型对re - ETV失败相对于ETV失败的风险比进行校正估计。使用肯德尔tau系数计算ETVSS与re - ETV成功机会之间的相关系数。使用c统计量对模型辨别力进行量化。还分析了术中发现和处理对re - ETV成功的影响。结果：re - ETV失败相对于ETV失败的风险比为1.23（95%可信区间0.90 - 1.69；p = 0.20）。6个月时，ETV和re - ETV的成功率均为68%。ETVSS与re - ETV成功机会显著相关（τ = 0.37；95%偏差校正和加速可信区间0.21 - 0.52；p < 0.001）。c统计量为0.74（95%可信区间0.64 - 0.85）。脑桥前蛛网膜的存在和使用外部脑室引流管（EVD）与治疗成功呈负相关，比值比分别为4.0（95%可信区间1.5 - 10.5）和9.7（95%可信区间3.4 - 27.8）。结论：re - ETV似乎与初始ETV一样安全有效。ETVSS能充分预测re - ETV成功的机会。脑桥前蛛网膜的存在和EVD的使用会对成功机会产生负面影响。
