Lane Jessica, Akbari Syed Hassan A
Department of Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, USA.
Cureus. 2022 May 19;14(5):e25136. doi: 10.7759/cureus.25136. eCollection 2022 May.
Endoscopic third ventriculostomy (ETV) is an alternative to cerebrospinal fluid (CSF) shunting in the treatment of hydrocephalus. Careful patient selection is critical as patient age, etiology of hydrocephalus, and previous shunting have been shown to influence ETV success rates. Intraoperatively, patient anatomy and medical stability may prevent or limit the completion of the ventriculostomy procedure, and findings such as a patulous third ventricular floor or cisternal scarring may portend a lower chance of successful hydrocephalus treatment. Patients in whom a ventriculostomy is completed may still experience continued symptoms of hydrocephalus or CSF leak, representing an early ETV failure. In other patients, the ETV may prove a durable treatment of hydrocephalus for several months or even years before recurrence of hydrocephalus symptoms. The failure pattern for ETV is different than that of shunting, with a higher early failure rate but improved long-term failure-free survival rates. The risk factors for failure, along with the presentation and management of failure, deserve review.
内镜下第三脑室造瘘术（ETV）是治疗脑积水时脑脊液分流术的一种替代方法。谨慎选择患者至关重要，因为患者年龄、脑积水病因和既往分流史已被证明会影响ETV的成功率。术中，患者的解剖结构和医疗稳定性可能会妨碍或限制造瘘手术的完成，而诸如第三脑室底部松弛或脑池瘢痕形成等发现可能预示脑积水治疗成功的几率较低。完成造瘘术的患者仍可能持续出现脑积水症状或脑脊液漏，这代表早期ETV失败。在其他患者中，ETV可能在脑积水症状复发前数月甚至数年都能有效治疗脑积水。ETV的失败模式与分流术不同，早期失败率较高，但长期无失败生存率有所提高。失败的风险因素以及失败的表现和处理值得探讨。
