Rocque Brandon G, Jensen Hailey, Reeder Ron W, Kulkarni Abhaya V, Pollack Ian F, Wellons John C, Naftel Robert P, Jackson Eric M, Whitehead William E, Pindrik Jonathan A, Limbrick David D, McDonald Patrick J, Tamber Mandeep S, Hankinson Todd C, Hauptman Jason S, Krieger Mark D, Chu Jason, Simon Tamara D, Riva-Cambrin Jay, Kestle John R W, Rozzelle Curtis J
1Department of Neurosurgery, Children's of Alabama, The University of Alabama at Birmingham, Alabama.
Departments of2Pediatrics and.
J Neurosurg Pediatr. 2022 Jul 29;30(4):428-436. doi: 10.3171/2022.6.PEDS22177. Print 2022 Oct 1.
Endoscopic third ventriculostomy (ETV) is an option for treatment of hydrocephalus, including for patients who have a history of previous treatment with CSF shunt insertion. The purpose of this study was to report the success of postshunt ETV by using data from a multicenter prospective registry.
Prospectively collected data in the Hydrocephalus Clinical Research Network (HCRN) Core Data Project (i.e., HCRN Registry) were reviewed. Children who underwent ETV between 2008 and 2019 and had a history of previous treatment with a CSF shunt were included. A Kaplan-Meier survival curve was created for the primary outcome: time from postshunt ETV to subsequent CSF shunt placement or revision. Univariable Cox proportional hazards models were created to evaluate for an association between clinical and demographic variables and subsequent shunt surgery. Postshunt ETV complications were also identified and categorized.
A total of 203 children were included: 57% male and 43% female; 74% White, 23% Black, and 4% other race. The most common hydrocephalus etiologies were postintraventricular hemorrhage secondary to prematurity (56, 28%) and aqueductal stenosis (42, 21%). The ETV Success Score ranged from 10 to 80. The median patient age was 4.1 years. The overall success of postshunt ETV at 6 months was 41%. Only the surgeon's report of a clear view of the basilar artery was associated with a lower likelihood of postshunt ETV failure (HR 0.43, 95% CI 0.23-0.82, p = 0.009). None of the following variables were associated with postshunt ETV success: age at the time of postshunt ETV, etiology of hydrocephalus, sex, race, ventricle size, number of previous shunt operations, ETV performed at time of shunt infection, and use of external ventricular drainage. Overall, complications were reported in 22% of patients, with CSF leak (8.6%) being the most common complication.
Postshunt ETV was successful in treating hydrocephalus, without subsequent need for a CSF shunt, in 41% of patients, with a clear view of the basilar artery being the only variable significantly associated with success. Complications occurred in 22% of patients. ETV is an option for treatment of hydrocephalus in children who have previously undergone shunt placement, but with a lower than expected likelihood of success.
内镜下第三脑室造瘘术（ETV）是治疗脑积水的一种选择，包括既往有脑脊液分流置入史的患者。本研究的目的是通过多中心前瞻性登记数据报告分流术后ETV的成功率。
回顾了脑积水临床研究网络（HCRN）核心数据项目（即HCRN登记处）前瞻性收集的数据。纳入2008年至2019年间接受ETV且既往有脑脊液分流治疗史的儿童。为主要结局创建了Kaplan-Meier生存曲线：从分流术后ETV到随后进行脑脊液分流置入或翻修的时间。创建单变量Cox比例风险模型以评估临床和人口统计学变量与随后的分流手术之间的关联。还识别并分类了分流术后ETV的并发症。
共纳入203名儿童：男性占57%，女性占43%；74%为白人，23%为黑人，4%为其他种族。最常见的脑积水病因是早产继发脑室内出血（56例，28%）和导水管狭窄（42例，21%）。ETV成功评分范围为10至80分。患者中位年龄为4.1岁。分流术后ETV在6个月时的总体成功率为41%。只有外科医生报告能清楚看到基底动脉与分流术后ETV失败的可能性较低相关（风险比0.43，95%置信区间0.23 - 0.82，p = 0.009）。以下变量均与分流术后ETV成功无关：分流术后ETV时的年龄、脑积水病因、性别、种族、脑室大小、既往分流手术次数、在分流感染时进行的ETV以及使用外部脑室引流。总体而言，22%的患者报告有并发症，脑脊液漏（8.6%）是最常见的并发症。
分流术后ETV在41%的患者中成功治疗了脑积水，无需随后进行脑脊液分流，能清楚看到基底动脉是与成功显著相关的唯一变量。22%的患者发生了并发症。ETV是既往接受过分流置入的儿童脑积水治疗的一种选择，但成功率低于预期。
