Department of Neurosurgery, University Hospital of Wales, Cardiff, UK; Neuroscience and Mental Health Research Institute (NMHRI), School of Medicine, Cardiff University, UK.
Department of Neurosurgery, University Hospital of Wales, Cardiff, UK.
Eur J Paediatr Neurol. 2020 May;26:7-14. doi: 10.1016/j.ejpn.2020.02.011. Epub 2020 Feb 24.
Hydrocephalus is a major cause of morbidity in the pediatric population, with potentially severe consequences if left untreated. Two viable strategies for management of non-communicating hydrocephalus are endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunting. However, there is uncertainty over the safety and efficacy of ETV in younger infants aged 1 year or below. In this systematic review, we aim to elucidate the success rate and procedural risks of ETV in this age group.
A multi-database (PubMed, Embase, Web of Science) literature search between January 1990 and April 2018 was performed in accordance with PRISMA guidelines. Eligible studies were included if they (i) examined non-communicating hydrocephalus; (ii) quantified the success/failure rates of ETV; and (iii) assessed outcomes in children 1 year of age or younger.
A total of 19 articles with 399 patients were eligible for inclusion. Mean age at procedure was 4.2 months (range 34 weeks gestation to 12 months), with 116 females and 143 males. Commonest underlying aetiology was congenital aqueductal stenosis (AS) (60.4%). Remaining causes included post-haemorrhagic, post-infection, Chiari malformations, malignancies and others. Overall and AS mean success rates were 51.6% and 56.5% respectively. Overall complication rate was 10.0%, consisting mainly of CSF leak, infection, and haemorrhage. Younger age was significantly associated with poorer ETV success rate when divided into <6 months and 6-12 months of age (44.4 vs 66.7%; p = 0.0007). Underlying pathology had no significant association with ETV outcome when divided into AS and other pathologies (p = 0.53).
Age is significantly associated with ETV success rates. Pathology-dependent effects were not found in this age group. Despite a lower ETV success rate at younger ages (44.4 vs 66.7%), it offers a comparable safety profile that is independent of age. ETV remains a viable treatment option for non-communicating hydrocephalus for infants aged 1 year or younger.
脑积水是儿科患者发病率的主要原因，如果不治疗，可能会产生严重后果。治疗非交通性脑积水的两种可行策略是内镜第三脑室造瘘术（ETV）和脑室-腹腔分流术。然而，对于年龄在 1 岁或以下的婴儿，ETV 的安全性和有效性尚不确定。在这项系统评价中，我们旨在阐明该年龄段 ETV 的成功率和程序风险。
根据 PRISMA 指南，对 1990 年 1 月至 2018 年 4 月的多个数据库（PubMed、Embase、Web of Science）进行了文献检索。符合条件的研究包括：（i）研究非交通性脑积水；（ii）量化 ETV 的成功率/失败率；（iii）评估 1 岁或以下儿童的结果。
共有 19 篇文章的 399 名患者符合纳入标准。手术时的平均年龄为 4.2 个月（胎龄 34 周至 12 个月），其中 116 名女性和 143 名男性。最常见的潜在病因是先天性导水管狭窄（AS）（60.4%）。其余病因包括出血后、感染后、Chiari 畸形、恶性肿瘤等。总体和 AS 的平均成功率分别为 51.6%和 56.5%。总的并发症发生率为 10.0%，主要为脑脊液漏、感染和出血。当分为<6 个月和 6-12 个月时，年龄较小与 ETV 成功率显著相关（44.4%比 66.7%；p=0.0007）。将潜在病理学分为 AS 和其他病理学时，与 ETV 结果无显著相关性（p=0.53）。
年龄与 ETV 成功率显著相关。在该年龄组中未发现与病理学相关的影响。尽管在年龄较小的婴儿中 ETV 的成功率较低（44.4%比 66.7%），但它提供了一种与年龄无关的类似安全性。对于 1 岁或以下的婴儿，ETV 仍然是治疗非交通性脑积水的可行选择。
