Department of Neurosurgery, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Via Altura 3, 40139, Bologna, Italy.
Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.
Acta Neurochir (Wien). 2021 Dec;163(12):3343-3352. doi: 10.1007/s00701-021-04983-0. Epub 2021 Sep 7.
Longstanding overt ventriculomegaly in adults (LOVA) represents a form of chronic adulthood hydrocephalus with symptomatic manifestation in late adulthood. Based on the patency of the aqueduct, two different subcohorts of LOVA can be distinguished. Surgical treatments of this condition are also debated. Therefore, we analyzed preoperative characteristics and clinical outcome after different surgical treatments in a subgroup of LOVA patients with a patent aqueduct.
Eighteen LOVA patients with a patent aqueduct consecutively treated at our institution between July 2013 and December 2019 were analyzed for this study. Median age was 70 years. Preoperative radiological and clinical features, surgical procedures (ventriculo-peritoneal shunt or endoscopic third ventriculostomy), and outcomes were collected. Successful outcome was qualitatively defined as an improvement or a halt of progression of the presenting symptoms at follow-up, and quantitatively by changes in mRS and iNPHGS scales.
Twelve patients underwent an ETV as a primary treatment, while 6 underwent VPS. A total of 22.2% of them were lost to follow-up. Median follow-up time was 38 months. Six patients (66.7%) in the ETV cohort achieved a successful outcome after treatment, with a complication rate of 11.1%. Two patients underwent rescue VPS after ETV failure with a good outcome. Four patients (100%) underwent primary VPS and achieved a satisfactory outcome after treatment, with a reported complications rate of 25%.
LOVA with patent aqueduct represents, in our opinion, a distinct clinical form of chronic hydrocephalus. For this subgroup, as well as for other forms of LOVA, ETV remains an acceptable first-line treatment option considering the good results, and the low complication rate, obtained in those patients and the hypothesis that hydrocephalus is due to an "intracisternal" obstruction.
成人长期（LOVA）明显脑室扩大代表了一种慢性成人脑积水，在成年晚期表现出症状。根据导水管的通畅情况，LOVA 可分为两个不同的亚组。这种情况下的手术治疗也存在争议。因此，我们分析了导水管通畅的 LOVA 亚组患者接受不同手术治疗的术前特征和临床结果。
本研究分析了 2013 年 7 月至 2019 年 12 月我院连续收治的 18 例导水管通畅的 LOVA 患者。中位年龄为 70 岁。收集了术前影像学和临床特征、手术过程（脑室-腹腔分流术或内镜第三脑室造瘘术）和结果。成功的结果通过随访时出现的症状的改善或停止进展来定性定义，并通过 mRS 和 iNPHGS 量表的变化来定量定义。
12 例患者作为主要治疗方法接受了 ETV，而 6 例患者接受了 VPS。其中 22.2%的患者失访。中位随访时间为 38 个月。ETV 组 6 例（66.7%）患者治疗后取得了成功的结果，并发症发生率为 11.1%。2 例 ETV 失败后行挽救性 VPS，结果良好。4 例（100%）患者行原发性 VPS，治疗后结果满意，并发症发生率为 25%。
我们认为，导水管通畅的 LOVA 代表了一种独特的慢性脑积水临床形式。对于这个亚组，以及对于其他形式的 LOVA，ETV 仍然是一种可接受的一线治疗选择，因为在这些患者中取得了良好的效果和较低的并发症发生率，并且假设脑积水是由于“颅内”阻塞引起的。
