Yadav Awdhesh, Verma Rajat
Department of Neurosurgery, King George's Medical University, Lucknow, IND.
Cureus. 2022 Feb 18;14(2):e22354. doi: 10.7759/cureus.22354. eCollection 2022 Feb.
Introduction Hydrocephalus is an excessive accumulation of cerebrospinal fluid (CSF) in the cavity and spaces of the brain. To date, there is no single method to accurately assess the compliance of subarachnoid spaces after endoscopic third ventriculostomy (ETV). Objective To analyze the intracranial pressure (ICP) trends in the early postoperative period in infants undergoing ETV for congenital hydrocephalus and correlate them with the final outcome. Material and methods This is a single-center prospective study conducted at the Department of Neurosurgery of our institute from January 2019 to February 2020. Infants presented with congenital hydrocephalus mandating ETV were included in the study. ICP was continuously monitored for the first three days after the procedure. ICP values were recorded hourly, and 24 ICP values obtained daily were averaged to obtain a daily average value (DAV). Results Forty patients were recruited in the study. The mean age of the study population was 4.7 ± 2.8 months; 80% of the infants were <6 months of age. The male/female ratio was 5.7:1. The most common etiology was congenital aqueductal stenosis, which was observed in 18 (45%) of the patients, followed by Dandy-Walker malformation (DWM) in 11 (27.5%) of the patients. On considering a difference of >1 mmHg between the first and third postoperative day, the ETV success rate was dropped from 50% in stable trend to 11% in progressive increase trend, which was statistically significant (p = 0.044). At DAV variation of >2 mmHg in progressive increase trend, the sensitivity of stable ICP trend increased to 100% in predicting ETV success. Also, the negative predictive value (the ability of a stable trend to rule out ETV failure) reached 100%. The overall success rates of ETV in our study at one, three, and six months were 62.5%, 40%, and 35%, respectively. Conclusion A progressive increase in the ICP trend (with a difference of >2 mmHg between postoperative days 1 and 3) was the best predictor of ETV failure in our study. It was superior to any other clinical or radiological variable in our study, which was affecting the outcome.
引言
脑积水是指脑脊液（CSF）在脑腔和脑间隙中过度积聚。迄今为止，尚无单一方法可准确评估内镜下第三脑室造瘘术（ETV）后蛛网膜下腔的顺应性。
目的
分析先天性脑积水患儿接受ETV术后早期的颅内压（ICP）变化趋势，并将其与最终结局相关联。
材料与方法
这是一项于2019年1月至2020年2月在我院神经外科进行的单中心前瞻性研究。纳入因先天性脑积水而需行ETV的婴儿。术后前三天持续监测ICP。每小时记录ICP值，将每日获得的24个ICP值求平均值以获得每日平均值（DAV）。
结果
本研究共招募了40例患者。研究人群的平均年龄为4.7±2.8个月；80%的婴儿年龄小于6个月。男女比例为5.7:1。最常见的病因是先天性导水管狭窄，18例（45%）患者出现该病因，其次是Dandy-Walker畸形（DWM），11例（27.5%）患者出现该病因。若术后第一天和第三天的差值>1 mmHg，ETV成功率从稳定趋势下的50%降至逐渐升高趋势下的11%，具有统计学意义（p = 0.044）。在逐渐升高趋势下，若DAV变化>2 mmHg，稳定ICP趋势预测ETV成功的敏感性增至100%。此外，阴性预测值（稳定趋势排除ETV失败的能力）达到100%。本研究中ETV在1个月、3个月和6个月时的总体成功率分别为62.5%、40%和35%。
结论
在本研究中，ICP趋势逐渐升高（术后第1天和第3天差值>2 mmHg）是ETV失败的最佳预测指标。它优于本研究中影响结局的任何其他临床或影像学变量。
