Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA; Broad institute of MIT and Harvard, Cambridge, Massachusetts, USA; Harvard Center for Hydrocephalus and Neurodevelopmental Disorders, Massachusetts General Hospital, Boston, Massachusetts, USA.
World Neurosurg. 2023 Nov;179:158-166. doi: 10.1016/j.wneu.2023.08.071. Epub 2023 Aug 23.
Recently, intervention with endoscopic third ventriculostomy (ETV) for patients with idiopathic normal pressure hydrocephalus (iNPH) has emerged as a potential minimally invasive alternative to traditional treatments (ventriculoperitoneal shunting). The clinical response to these interventions is variable and unclear. The objective of this review was to assess the efficacy of endoscopic third ventriculostomy in treating patients with iNPH. A systematic review of PubMed, Web of Science, and Google Scholar was conducted using search terms relevant to ETV and iNPH. Included studies met consistent, predetermined diagnostic criteria for iNPH, implemented ETV in subjects greater than 40 years of age, and assessed all 3 components of Hakim's triad (gait impairment, dementia, and incontinence). Data extraction included dichotomization of successful ETV clinical outcomes and a subgroup meta-analysis of ETV success rates across binarized age groups. Meta-analysis was conducted using a Mantel-Haenszel fixed-effects model. The outcomes presented include generalized ETV success rates across all 12 studies. Age-specific individual data was measured with odds ratios, with a pooled statistic measured using the Mantel-Haenszel test. Overall, 2294 studies were identified in this search, of which 12 were selected for inclusion in this systematic review. Of these, 3 studies were utilized for age-specific meta-analyses. Preliminary synthesis of ETV clinical outcomes across all 12 studies revealed a success rate of 60.2%. Additionally, meta-analysis revealed that iNPH patients younger than or equal to 65 years of age were significantly more likely to respond successfully to ETV intervention. Heterogeneity was inconsequential in this analysis.
最近，内镜第三脑室造瘘术（ETV）已成为治疗特发性正常压力脑积水（iNPH）的一种潜在微创替代方法，与传统治疗（脑室-腹腔分流术）相比。这些干预措施的临床反应是可变的，尚不清楚。本综述的目的是评估内镜第三脑室造瘘术治疗 iNPH 患者的疗效。使用与 ETV 和 iNPH 相关的搜索词，对 PubMed、Web of Science 和 Google Scholar 进行了系统评价。纳入的研究符合 iNPH 的一致、预先确定的诊断标准，在年龄大于 40 岁的受试者中实施 ETV，并评估了 Hakim 三联征（步态障碍、痴呆和失禁）的所有 3 个组成部分。数据提取包括成功的 ETV 临床结果的二分法和基于二分年龄组的 ETV 成功率的亚组荟萃分析。荟萃分析使用 Mantel-Haenszel 固定效应模型进行。呈现的结果包括 12 项研究中所有 ETV 的总体成功率。使用优势比测量特定年龄的个体数据，使用 Mantel-Haenszel 检验测量汇总统计数据。总的来说，在这次搜索中确定了 2294 项研究，其中有 12 项被选中纳入本系统综述。其中，有 3 项研究用于特定年龄的荟萃分析。对 12 项研究的 ETV 临床结果进行初步综合分析显示，成功率为 60.2%。此外，荟萃分析表明，年龄在 65 岁及以下的 iNPH 患者对 ETV 干预的反应更有可能成功。在这项分析中，异质性并不重要。
