Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Dhaka 1205, Bangladesh.
Department of Neurosurgery, Azienda Ospedaliera Universitaria Pisana (AOUP), University of Pisa, 56100 Pisa, Italy.
Medicina (Kaunas). 2022 Feb 13;58(2):281. doi: 10.3390/medicina58020281.
Ventriculoperitoneal Shunt (VPS) and Endoscopic Third Ventriculostomy (ETV) are both gold standard procedures to reduce intracranial pressure (ICP) in patients with obstructive hydrocephalus, which often results in papilledema. This comparative study was carried out at the Department of Neurosurgery of Dhaka Medical College and Hospital to compare the efficacy of VPS and ETV in the resolution of papilledema in 18 patients with obstructive hydrocephalus. The success of CSF diversion was evaluated by a decrease in retinal nerve fiber layer (RNFL) thickness by optical coherence tomography (OCT) and modified Frisen grading of papilledema at the same time. The statistical analyses were carried out by using paired sample t test and the Spearman's correlation coefficient test. The level of significance ( value) was set at <0.05. After 7 days, both VPS and ETV were able to reduce RNFL thickness of both eyes with a value = 0.016 (right eye) and 0.003 (left eye) in group A (VPS) and with a value <0.001 (both eyes) in group B (ETV). Change of Frisen grading after CSF diversion was not satisfying for both the procedures with value > 0.05. Further, the inter-group comparison between VPS and ETV showed no difference in decreasing RNFL thickness and modified Frisen grading ( value = 0.56). VPS and ETV procedures both appear very efficient in treating obstructive hydrocephalus, which in turn reduces papilledema in these patients. This paper is preliminary and requires further work.
脑室-腹腔分流术（VPS）和内镜第三脑室造瘘术（ETV）都是降低梗阻性脑积水患者颅内压（ICP）的金标准方法，这通常会导致视乳头水肿。这项对比研究是在达卡医学院附属医院神经外科进行的，比较了 VPS 和 ETV 治疗 18 例梗阻性脑积水患者视乳头水肿的疗效。通过光学相干断层扫描（OCT）评估 CSF 引流的成功，同时评估视乳头水肿的改良 Frisen 分级和视网膜神经纤维层（RNFL）厚度的变化。采用配对样本 t 检验和斯皮尔曼相关系数检验进行统计学分析。显著性水平（ 值）设定为<0.05。7 天后，VPS 和 ETV 均能降低双眼的 RNFL 厚度，A 组（VPS）的 值分别为 0.016（右眼）和 0.003（左眼），B 组（ETV）的 值<0.001（双眼）。两种手术在 CSF 分流后 Frisen 分级的变化都不令人满意， 值>0.05。此外，VPS 和 ETV 之间的组间比较显示，降低 RNFL 厚度和改良 Frisen 分级的差异无统计学意义（ 值=0.56）。VPS 和 ETV 两种手术方法都非常有效地治疗梗阻性脑积水，从而降低了这些患者的视乳头水肿。本文是初步的，需要进一步的工作。
