Choudhary Ajay, Sobti Shivender, Zambre Sourabh, Bhaskar Suryanarayanan
Department of Neurosurgery, ABVIMS and Dr. RML Hospital, New Delhi, India.
Department of Neurosurgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
Asian J Neurosurg. 2020 Oct 19;15(4):937-940. doi: 10.4103/ajns.AJNS_117_20. eCollection 2020 Oct-Dec.
Ventriculoperitoneal (VP) shunt malfunction is common in pediatric age group patients. There is a high complication rate and revision rate of VP shunt. Endoscopic third ventriculostomy (ETV) can alleviate these complications and can act as an effective alternative for the treatment of hydrocephalus in this age group of patients.
The authors retrospectively reviewed the management and outcome of 36 failed VP shunts in pediatric patients for the treatment of hydrocephalus. The surgeries were performed between November 2010 and January 2016 in a tertiary care hospital. The minimal follow-up period was 3 months. We divided the patients into the following age groups: <1 year (eight infants), 1-10 years (18 children), and 10-18 years (10 children). The success of the procedure was determined by age, sex, type of hydrocephalus, and the number of shunt revisions and malfunction before ETV. Children with different age ( = 0.839) and sex group did not show any significant data ( = 0.798). Children with communicating hydrocephalus had a success rate of 52.9% (17 patients), and children with noncommunicating hydrocephalus had a success rate of 84.2% (19 patients). The success rate in children with only one shunt malfunction was 57.1% (21 patients), whereas in 15 children with two or more shunt malfunctions, the success rate of ETV was 86.7%.
The authors conclude that ETV is an effective alternative for the treatment of hydrocephalus in children. Age does not present a contraindication for ETV in failed VP shunt.
脑室腹腔（VP）分流术故障在儿科患者中很常见。VP分流术的并发症发生率和翻修率都很高。内镜下第三脑室造瘘术（ETV）可以缓解这些并发症，并且可以作为该年龄组脑积水治疗的有效替代方法。
作者回顾性分析了36例儿科患者因脑积水导致VP分流失败后的治疗及结果。手术于2010年11月至2016年1月在一家三级医疗中心进行。最短随访期为3个月。我们将患者分为以下年龄组：<1岁（8名婴儿）、1-10岁（18名儿童）和10-18岁（10名儿童）。手术的成功与否由年龄、性别、脑积水类型以及ETV前分流翻修次数和故障情况决定。不同年龄组（P = 0.839）和性别组的儿童未显示出任何显著数据（P = 0.798）。交通性脑积水儿童的成功率为52.9%（17例患者），非交通性脑积水儿童的成功率为84.2%（19例患者）。仅有一次分流故障的儿童成功率为57.1%（21例患者），而在15例有两次或更多次分流故障的儿童中，ETV的成功率为86.7%。
作者得出结论，ETV是治疗儿童脑积水的有效替代方法。年龄并非VP分流失败后ETV的禁忌证。
