Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.
David Geffen School of Medicine, University of California, Los Angeles, California.
Neurosurgery. 2019 Oct 1;85(4):E714-E721. doi: 10.1093/neuros/nyz122.
There are currently no published data directly comparing postoperative seizure incidence following endoscopic third ventriculostomy (ETV), with/without choroid plexus cauterization (CPC), to that for ventriculoperitoneal shunt (VPS) placement.
To compare postoperative epilepsy incidence for ETV/CPC and VPS in Ugandan infants treated for postinfectious hydrocephalus (PIH).
We performed an exploratory post hoc analysis of a randomized trial comparing VPS and ETV/CPC in 100 infants (<6 mo old) presenting with PIH. Minimum follow-up was 2 yr. Variables associated with and the incidence of postoperative epilepsy were compared (intention-to-treat) using a bivariate analysis. Time to first seizure was compared using the Kaplan-Meier method, and the relative risk for the 2 treatments was determined using Mantel-Haenszel hazard ratios.
Seizure incidence was not related to age (P = .075), weight (P = .768), sex (P = .151), head circumference (P = .281), time from illness to hydrocephalus onset (P = .973), or hydrocephalus onset to treatment (P = .074). Irritability (P = .027) and vision deficit (P = .04) were preoperative symptoms associated with postoperative seizures. Ten (10%) patients died, and 20 (20%) developed seizures over the follow-up period. Overall seizure incidence was 9.4 per 100 person-years (9.4 and 9.5 for ETV/CPC and VPS, respectively; P = .483), with no significant difference in seizure risk between groups (hazard ratio, 1.02; 95% CI: 0.42, 2.45; P = .966). Mean time to seizure onset was 8.5 mo for ETV/CPC and 11.2 mo for VPS (P = .464). As-treated, per-protocol, and attributable-intervention analyses yielded similar results.
Postoperative seizure incidence following treatment of PIH was 20% within 2 yr, regardless of treatment modality.
目前尚无直接比较内镜第三脑室造瘘术（ETV）联合/不联合脉络丛烧灼术（CPC）与脑室-腹腔分流术（VPS）术后癫痫发作发生率的研究数据。
比较内镜第三脑室造瘘术联合/不联合脉络丛烧灼术（ETV/CPC）与 VPS 治疗感染后脑积水（PIH）婴儿术后癫痫的发生率。
我们对一项比较 VPS 与 ETV/CPC 治疗 100 例 PIH 婴儿的随机试验进行了探索性事后分析。随访时间至少为 2 年。采用双变量分析比较术后癫痫相关的变量和癫痫的发生率（意向治疗）。采用 Kaplan-Meier 法比较首次癫痫发作时间，采用 Mantel-Haenszel 风险比确定两种治疗方法的相对风险。
癫痫发作的发生率与年龄（P=0.075）、体重（P=0.768）、性别（P=0.151）、头围（P=0.281）、从疾病到脑积水发病的时间（P=0.973）或脑积水发病到治疗的时间（P=0.074）无关。术前出现烦躁（P=0.027）和视力障碍（P=0.04）与术后癫痫发作相关。10 例（10%）患者死亡，20 例（20%）患者在随访期间出现癫痫发作。总的癫痫发作发生率为每 100 人年 9.4 例（ETV/CPC 组和 VPS 组分别为 9.4 和 9.5 例；P=0.483），两组癫痫发作风险无显著差异（风险比为 1.02；95%CI：0.42，2.45；P=0.966）。ETV/CPC 组的癫痫发作中位时间为 8.5 个月，VPS 组为 11.2 个月（P=0.464）。实际治疗、符合方案和归因于干预的分析得出了相似的结果。
在 2 年内，无论治疗方式如何，PIH 患儿治疗后的癫痫发作发生率为 20%。
