Bowes Amy L, King-Robson Josh, Dawes William J, James Greg, Aquilina Kristian
Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children, London, United Kingdom.
J Neurosurg Pediatr. 2017 Oct;20(4):324-328. doi: 10.3171/2017.4.PEDS16488. Epub 2017 Jul 28.
OBJECTIVE The aim of this study was to review the safety of pediatric intraventricular endoscopy across separate age groups and to determine whether intraventricular endoscopy is associated with an increased risk of complications or reduced efficacy in infants younger than 1 year. METHODS In this retrospective cohort study, 286 pediatric patients younger than 17 years underwent intraventricular endoscopy at Great Ormond Street Hospital between December 2005 and December 2014. The primary diagnosis, procedure, and complications were recorded. RESULTS Neuroendoscopic surgery was performed in 286 pediatric patients (51 neonates 0-6 months [Group 1]; 37 infants 6-12 months [Group 2]; 75 patients 1-5 years [Group 3]; 54 patients 5-10 years [Group 4]; and 69 patients ≥ 10 years [Group 5]; male/female ratio 173:113). The most common procedures included endoscopic third ventriculostomy (ETV) in 159 patients and endoscopic fenestration of intracranial cysts in 64 patients. A total of 348 consecutive neuroendoscopic procedures were undertaken. Nine different complications were identified, of which postoperative seizures (1.7%), CSF leak (3.1%), CSF infection (2.4%), and intracranial hemorrhage (1.7%) were the most common. Specifically, no significant difference in complication rate (11.9%) or infection rate (2.4%) was observed among age groups (p = 0.40 and p = 0.91, respectively). In addition, there were no perioperative deaths; 30-day mortality was 1.1%. After neuroendoscopy for CSF diversion (n = 227), a significantly higher rate of shunt insertion was observed in the youngest group (Group 1, 63.0%) when compared with older groups (Group 2, 46.4%; Group 3, 26.3%; Group 4, 38.6%; and Group 5, 30.8%; p = 0.03). Similarly, for patients who underwent ETV as their initial neuroendoscopic procedure or in combination with additional surgical interventions (n = 171), a significantly higher rate of shunt insertion was also observed within young infants (Group 1, 67.9%; Group 2, 47.6%; Group 3, 19.6%; Group 4, 27.3%; and Group 5, 23.3%; p = 0.003). CONCLUSIONS Intraventricular endoscopy is a safe neurosurgical intervention in pediatric patients of all ages, although it might be associated with increased shunt rates after endoscopic surgery, specifically ETV, in younger infants.
目的 本研究旨在回顾不同年龄组小儿脑室内内镜检查的安全性，并确定脑室内内镜检查是否与1岁以下婴儿并发症风险增加或疗效降低相关。方法 在这项回顾性队列研究中，2005年12月至2014年12月期间，286例17岁以下的小儿患者在大奥蒙德街医院接受了脑室内内镜检查。记录了主要诊断、手术过程和并发症。结果 286例小儿患者接受了神经内镜手术（51例0至6个月的新生儿[第1组]；37例6至12个月的婴儿[第2组]；75例1至5岁患者[第3组]；54例5至10岁患者[第4组]；69例≥10岁患者[第5组]；男女比例为173:113）。最常见的手术包括159例患者的内镜下第三脑室造瘘术（ETV）和64例患者的颅内囊肿内镜开窗术。共进行了348例连续的神经内镜手术。确定了9种不同的并发症，其中术后癫痫（1.7%）、脑脊液漏（3.1%）、脑脊液感染（2.4%）和颅内出血（1.7%）最为常见。具体而言，各年龄组之间的并发症发生率（11.9%）或感染率（2.4%）无显著差异（p分别为0.40和0.91）。此外，无围手术期死亡；30天死亡率为1.1%。在进行脑脊液分流的神经内镜手术后（n = 227），最年幼组（第1组，63.%)的分流置入率明显高于年长组（第2组，46.4%；第3组，26.3%；第4组，).6%；第5组，30.8%；p = 0.03）。同样，对于最初接受ETV作为神经内镜手术或与其他手术干预联合进行的患者（n = 171），在小婴儿中也观察到明显更高的分流置入率（第1组，67.9%；第2组，47.6%；第3组，19.6%；第4组，27.3%；第5组，23.3%；p = 0.003）。结论 脑室内内镜检查是各年龄段小儿患者安全的神经外科干预措施，尽管在小婴儿中，尤其是ETV术后，内镜手术后的分流率可能会增加。
