Department of Neurosurgery, ASST Niguarda Hospital, Milan, Italy.
Service of Biostatistics, ASST Niguarda Hospital, Milan, Italy.
World Neurosurg. 2019 Jul;127:e799-e808. doi: 10.1016/j.wneu.2019.03.268. Epub 2019 Apr 4.
Endoscopic third ventriculostomy (ETV) is now widely used to manage ventriculoperitoneal shunt (VPS) malfunctions, but outcome predictors are still debated. Different opinions exist about the prognostic factors, but shunt duration is generally considered unimportant although its influence remains poorly investigated.
A total of 139 patients undergoing ETV for VPS malfunction were reviewed. Successful ETV was defined as shunt independence. There were 56 children and 83 adults; hydrocephalus had different causes. The mean VPS-ETV interval was 8.1 years.
Ninety patients (64.7%) became shunt free. Children and adults achieved comparable success rates (64.3% and 65.1%, respectively). Age, gender, and cause of shunt malfunction were scarcely significant. The success rates were 86.8% (33/38 patients) in obstructive hydrocephalus (OH), 55.2% (36/67) in communicating hydrocephalus, and 58.8% (21/34) in myelomeningocele-related hydrocephalus, which was significant (P = 0.02). History of multiple revisions was a negative predictor (P < 0.001): success rate, 39% (16/48) versus 81.3% (74/91). Any individual time step increase reduced the odds of ETV success by 34% (P = 0.014). In OH, the results were good regardless of any other factor, including shunt duration. In communicating hydrocephalus, short VPS-ETV intervals correlated with better outcome (P = 0.021), although they were irrelevant in perinatal posthemorrhagic hydrocephalus. In myelomeningocele-related hydrocephalus, shunt duration had intermediate effects.
ETV is the first option for shunt malfunctions in OH and perinatal posthemorrhagic hydrocephalus, regardless of other factors. Conversely, in other types of hydrocephalus, the chances of shunt independence are lower and shunt duration and history of multiple shunt revisions are significant.
内镜第三脑室造瘘术（ETV）现在广泛用于治疗脑室-腹腔分流术（VPS）故障，但预测结果的因素仍存在争议。对于预后因素存在不同意见，但尽管其影响仍未得到充分研究，但分流管使用时间通常被认为不重要。
回顾性分析 139 例行 ETV 治疗 VPS 故障的患者。成功的 ETV 定义为分流管独立。患者中有 56 例儿童和 83 例成人；脑积水有不同的病因。VPS-ETV 间隔的平均时间为 8.1 年。
90 例（64.7%）患者成功摆脱分流管。儿童和成人的成功率相当（分别为 64.3%和 65.1%）。年龄、性别和分流管故障的原因几乎没有显著意义。在梗阻性脑积水（OH）患者中，成功率为 86.8%（33/38 例），在交通性脑积水患者中为 55.2%（36/67 例），在脊髓脊膜膨出相关脑积水患者中为 58.8%（21/34 例），差异有统计学意义（P=0.02）。多次手术史是一个负面预测因素（P<0.001）：成功率为 39%（16/48）与 81.3%（74/91）。任何一个时间点的增加都会使 ETV 成功的几率降低 34%（P=0.014）。在 OH 中，无论其他任何因素，包括分流管使用时间，结果都很好。在交通性脑积水患者中，短的 VPS-ETV 间隔与更好的结果相关（P=0.021），尽管在围产期出血性脑积水患者中没有相关性。在脊髓脊膜膨出相关脑积水患者中，分流管使用时间的影响处于中间水平。
无论其他因素如何，在 OH 和围产期出血性脑积水患者中，ETV 是分流管故障的首选治疗方法。相反，在其他类型的脑积水患者中，分流管独立的可能性较低，分流管使用时间和多次分流管手术史是重要的影响因素。
