Nonaka Masahiro, Komori Yumiko, Isozaki Haruna, Ueno Katsuya, Kamei Takamasa, Takeda Junichi, Nonaka Yuichiro, Yabe Ichiro, Zaitsu Masayoshi, Nakashima Kenji, Asai Akio
Department of Neurosurgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan.
Department of Neurosurgery, Jikei Medical University, Minato-Ku, Tokyo, Japan.
Childs Nerv Syst. 2023 Nov;39(11):3137-3145. doi: 10.1007/s00381-022-05613-5. Epub 2022 Jul 30.
Little is known about the real-world status of neurosurgical treatment of myelomeningocele patients.
To investigate the real-world status of neurosurgical treatment of myelomeningocele patients, medical claims data provided by the Japan Medical Data Center (JMDC) were analyzed.
The health claims data of 556 patients with myelomeningoceles from January 2005 to March 2020 were examined. The number of neurosurgical procedures, including myelomeningocele repair, tethered cord release, cerebrospinal fluid (CSF) shunt, CSF drainage, and endoscopic third ventriculostomy (ETV), was determined.
A total of 313 neurosurgical procedures were performed for 135 patients in 74 institutions during the study period. The shunt survival rate was most affected by shunts that were revised when the patient was less than 1 year old, which had a significantly lower survival rate than all of the initial shunts performed when the patient was less than on1 year old; the 1-year shunt survival rate was 35 vs 64% (P = 0.0102). The survival rate was significantly lower in patients younger than 1 year who had CSF drainage before shunting compared to those younger than 1 year who did not have CSF drainage before shunting; the 1-year shunt survival rate was 27 vs 59% (P = 0.0196), and 81% of patients remained free of tethered cord release 10 years later.
In this study, a revised shunt of less than 1 year of age and CSF drainage before shunting were the factors that lowered the shunt survival rate in the real world for CSF shunts for hydrocephalus associated with myelomeningocele.
关于脊髓脊膜膨出患者神经外科治疗的真实世界状况知之甚少。
为调查脊髓脊膜膨出患者神经外科治疗的真实世界状况，对日本医疗数据中心（JMDC）提供的医疗理赔数据进行了分析。
检查了2005年1月至2020年3月期间556例脊髓脊膜膨出患者的健康理赔数据。确定了包括脊髓脊膜膨出修补术、脊髓拴系松解术、脑脊液（CSF）分流术、脑脊液引流术和内镜下第三脑室造瘘术（ETV）在内的神经外科手术数量。
在研究期间，74家机构的135例患者共进行了313例神经外科手术。分流器生存率受患者1岁以下时进行的分流器翻修影响最大，其生存率显著低于患者1岁以下时进行的所有初次分流器；1年分流器生存率分别为35%和64%（P = 0.0102）。与1岁以下分流术前未进行脑脊液引流的患者相比，1岁以下分流术前进行脑脊液引流的患者生存率显著更低；1年分流器生存率分别为27%和59%（P = 0.0196），81%的患者10年后仍未进行脊髓拴系松解术。
在本研究中，1岁以下的分流器翻修和分流术前的脑脊液引流是导致脊髓脊膜膨出相关脑积水的脑脊液分流器在现实世界中生存率降低的因素。
