Irrinki R N Naga Santhosh, Bawa Monika, Hegde Shalini, Chhabra Rajesh, Gupta Vivek, Gupta Sunil K
Department of General Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
J Pediatr Neurosci. 2019 Apr-Jun;14(2):65-69. doi: 10.4103/jpn.JPN_31_19.
Placement of ventriculoperitoneal shunt is a standard treatment for hydrocephalus. The risk of shunt malfunction in the first year is 25%-40% making endoscopic third ventriculostomy (ETV) a feasible option in those patients with shunt failure.
The aim of this study was to evaluate ETV as a viable option in patients with shunt malfunction and to correlate the clinical outcome following successful ETV with functional and radiological outcomes.
All patients who underwent ETV as a diversion procedure for hydrocephalus following shunt failure or malfunction over 1 year were studied. Functional outcome was evaluated by Wee function independence measure score carried out preoperatively, postoperatively, and at 6-month follow-up. Similar comparison was carried out for radiological parameters such as effacement of gyri, periventricular lucency, frontal horn diameter (maximum), Evans' index, and third ventricular diameter.
Of 15 patients, 61.5% were shunt free after ETV. All the failures were noted in the first month following the procedure. The factors, which showed statistically significant correlation with the outcome of ETV, included age ( = 0.030), preoperative functional score ( = 0.006), and all the three components of the functional scoring, namely self-care score ( = 0.087), motor control score ( = 0.035), and neurocognitive score ( = 0.003). Parameters such as Evans' index, maximum frontal horn diameter, and third ventricular diameter showed no significant difference between preoperative and postoperative scans. In follow-up imaging, only the frontal horn diameter showed a significant improvement ( = 0.047).
ETV leads to significant neurocognitive improvement and postoperative functional status making it a viable option in patients who present with shunt malfunction.
脑室腹腔分流术是脑积水的标准治疗方法。第一年分流失败的风险为25%-40%，这使得内镜下第三脑室造瘘术（ETV）成为分流失败患者的可行选择。
本研究的目的是评估ETV作为分流失败患者的可行选择，并将成功的ETV后的临床结果与功能和影像学结果相关联。
研究了所有在1年以上因分流失败或故障而接受ETV作为脑积水引流手术的患者。通过术前、术后和6个月随访时进行的Wee功能独立性测量评分来评估功能结果。对诸如脑回消失、脑室周围透亮、额角直径（最大值）、埃文斯指数和第三脑室直径等影像学参数进行了类似的比较。
15例患者中，61.5%在ETV后无需分流。所有失败均在手术后第一个月被发现。与ETV结果显示出统计学显著相关性的因素包括年龄（=0.030）、术前功能评分（=0.006）以及功能评分的所有三个组成部分，即自我护理评分（=0.087）、运动控制评分（=0.035）和神经认知评分（=0.003）。埃文斯指数、最大额角直径和第三脑室直径等参数在术前和术后扫描之间没有显著差异。在随访成像中，只有额角直径显示出显著改善（=0.047）。
ETV可导致显著的神经认知改善和术后功能状态，使其成为分流故障患者的可行选择。
