Shen Wenjun, Syed Hasan R, Gandhoke Gurpreet, Garcia Roxanna, Pundy Tatiana, Tomita Tadanori
Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Avenue, Chicago, IL, 60611-2605, USA.
Division of Pediatric Neurosurgery, Children's hospital of Fudan University, Shanghai, China.
Childs Nerv Syst. 2018 May;34(5):837-844. doi: 10.1007/s00381-017-3679-4. Epub 2017 Dec 16.
Endoscopic third ventriculostomy (ETV) provides a shunt-free treatment for obstructive hydrocephalus children. With rapidly evolving technology, the semi-rigid fiber optic neuroendoscopy shows a potential application in ETV by blunt fenestration. A retrospective analysis of our experience is reviewed.
The authors review infants and children who underwent ETV using this technique from June 2004 to June 2016 with radiological and clinical follow-up done by a single surgeon. Patients who underwent ETV with channel scope were excluded. Demographic variables and operative reports were collected. Improvement of preoperative symptoms and avoidance of additional cerebrospinal fluid (CSF) diversion procedures were considered a success. The ETV success score (ETVSS) was used to correlate with clinical outcomes.
A total of 79 patients were included with a mean age of 8.3 ± 5.5 years, and 40.5% were female. The mean clinical and radiographic follow-up was 38.6 ± 40.9 months. The overall complication rate was 6.3%, while 73.4% were considered successful. The ETV failure cases received conversion to ventriculoperitoneal shunt or redo of ETV with a median time of 2 months. The mean ETV success score was 74.3 ± 11.8 with positive correlation between success rate (P < 0.05). Kaplan-Meier failure-free survival rates of 30-day, 90-day, 6-month, 1-year, and 2-year were 89.9, 83.5, 78.5, 75.9, and 74.6%. Eight patients required redo ETV, and five of these patients required eventual shunt placements. Approximately 61.9% of failure occurred within 3 months. Patients with post-intraventricular hemorrhage (IVH) /infection, and age younger than 12 months had the poorest outcome (P < 0.05).
Blunt dissection of the third ventricle floor under endoscopic vision with the stylet tip of a fiber optic neuroendoscopy is safe and requires less equipment in the pediatric population. This technique is successful with an optimistic long-term outcome except for infants and the post-IVH and infectious subgroups.
内镜下第三脑室造瘘术（ETV）为梗阻性脑积水患儿提供了一种无需分流的治疗方法。随着技术的快速发展，半刚性光纤神经内镜通过钝性开窗在ETV中显示出潜在的应用价值。本文回顾了我们的相关经验。
作者回顾了2004年6月至2016年6月期间使用该技术接受ETV治疗的婴幼儿和儿童，由单一外科医生进行影像学和临床随访。排除使用通道内镜进行ETV的患者。收集人口统计学变量和手术报告。术前症状改善以及避免额外的脑脊液（CSF）分流手术被视为成功。使用ETV成功评分（ETVSS）与临床结果进行关联。
共纳入79例患者，平均年龄8.3±5.5岁，女性占40.5%。平均临床和影像学随访时间为38.6±40.9个月。总体并发症发生率为6.3%，而73.4%被认为治疗成功。ETV失败的病例转为脑室腹腔分流术或再次进行ETV，中位时间为2个月。ETV成功评分平均为74.3±11.8，与成功率呈正相关（P<0.05）。30天、90天、6个月、1年和2年的无失败生存率分别为89.9%、83.5%、78.5%、75.9%和74.6%。8例患者需要再次进行ETV，其中5例最终需要进行分流置管。约61.9%的失败发生在3个月内。脑室内出血（IVH）/感染后以及年龄小于12个月的患者预后最差（P<0.05）。
在内镜视野下用光纤神经内镜的探针尖端对第三脑室底部进行钝性分离在儿科患者中是安全的，且所需设备较少。除婴儿以及IVH后和感染亚组外，该技术成功率高，长期预后乐观。
