Rahman Md Moshiur, Khan S I M Khairun Nabi, Khan Robert Ahmed, Islam Rokibul, Sarker Mainul Haque
Neurosurgery Department, Holy Family Red Crescent Medical College, Dhaka, Bangladesh.
Neurosurgery Department, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
Chin Neurosurg J. 2021 Jan 6;7(1):3. doi: 10.1186/s41016-020-00228-8.
Endoscopic third ventriculostomy (ETV) has been established as a viable treatment option for obstructive hydrocephalus of children over 6 weeks of age. ETV in pediatric groups may be unsuccessful due to the failure of absorption of cerebrospinal fluid (CSF) or reclosure of ventriculostomy stoma or due to infection. The exact cause is still debatable. Some issues like failure to eliminate the second membrane during the procedure or formation of the new arachnoid membrane at the stoma are still not clear. This study aims to assess the surgical failure of ETV and its predisposing factors.
Thirty-four pediatric patients with hydrocephalus were analyzed retrospectively. The patients' age limit was between 2.5 months and 14 years. This is a retrospective study of 34 patients in a single private hospital between June 2012 and January 2018. Patients having hydrocephalus in pediatric groups more than 6 weeks of age were included in the study.
The mean age of all patients was 51.25 ± 53.90 months and the mean follow-up period was 50.47 ± 20.84 months. Of 34 surgeries, the success rate was 79% and the failure rate was 21%. Within 2 years, the success rate was 68.42% and above 2 years' success rate was 93.33%. In this series, 7 cases of ETV were re-explored and found ventriculostomy stoma closure in 3 cases, the presence of the second membrane in re-exploration 2 cases, and presence of inflammatory arachnoid membrane in re-exploration 2 cases. The use of dexamethasone around the stoma in inflammatory stoma was useful, having no recurrence. In one patient of the second membrane probably due to absorption failure in communicating hydrocephalus re-exploration was failed and was managed successfully with VP shunt.
Predisposing factors causing ETV failure are ventriculostomy stoma closure by new arachnoid granulation tissues, remnants of the second membrane inside the stoma, CSF absorption failure, infection/high protein in CSF and inappropriate patient selection.
内镜下第三脑室造瘘术（ETV）已被确立为6周龄以上儿童梗阻性脑积水的一种可行治疗选择。儿科患者的ETV可能因脑脊液（CSF）吸收失败、脑室造瘘口重新闭合或感染而不成功。确切原因仍有争议。一些问题，如手术过程中未能消除第二膜或造瘘口处新蛛网膜膜的形成，仍不清楚。本研究旨在评估ETV的手术失败情况及其易感因素。
回顾性分析34例小儿脑积水患者。患者年龄限制在2.5个月至14岁之间。这是对2012年6月至2018年1月期间一家私立医院的34例患者进行的回顾性研究。6周龄以上儿科组脑积水患者纳入研究。
所有患者的平均年龄为51.25±53.90个月，平均随访期为50.47±20.84个月。34例手术中，成功率为79%，失败率为21%。2年内，成功率为68.42%，2年以上成功率为93.33%。在本系列中，7例ETV进行了再次手术探查，发现3例脑室造瘘口闭合，再次手术探查时2例存在第二膜，2例存在炎性蛛网膜膜。在炎性造瘘口周围使用地塞米松是有效的，无复发。1例因交通性脑积水吸收失败导致第二膜形成的患者再次手术探查失败，成功进行了脑室腹腔分流术。
导致ETV失败的易感因素是新蛛网膜颗粒组织导致脑室造瘘口闭合、造瘘口内第二膜残留、脑脊液吸收失败、感染/脑脊液高蛋白以及患者选择不当。
