Konar Subhas, Singha Souvik, Shukla Dhaval, Sadashiva Nishanth, Prabhuraj Andiperumal Raj
Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India.
Lenox Hill Hospital, New York, US.
Childs Nerv Syst. 2024 Mar;40(3):685-693. doi: 10.1007/s00381-023-06210-w. Epub 2023 Nov 15.
The purpose of this study was to compare outcomes of endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunt (VPS) in children with symptomatic triventricular hydrocephalus due to primary aqueductal stenosis.
This is a retrospective analytical study. Patients who underwent either ETV or VPS as the first procedure for hydrocephalus due to primary aqueductal stenosis were included in the study.
A total of 89 children were included in the study for analysis. The mean age was 8.4 years. Forty-four (49.4%) had their first surgery as ETV and 45 (50.6%) had their first surgery as VPS. Overall, 34 (38.2%) patients required a second surgery (either ETV or VPS) for persistent or recurrent hydrocephalus. The mean follow-up duration was 832.9 days. The overall complication rate was 13.5%. The mean timing of the second surgery after index surgery was 601.35 days. Factors associated with a second surgery were the presence of complications, high protein in cerebrospinal fluid, the relative change of frontal-occipital horn ratio (FOHR) and Evans' index. The survival of the first surgery was superior in ETV (751.55 days) compared to VPS (454.49 days), p = 0.013. The relative change of fronto-occipital horn index ratio (FOIR) was high in the VPS (mean 7.28%) group compared to the ETV (mean 4.40%), p = 0.001 group.
Overall procedural survival was better after ETV than VPS for hydrocephalus due to aqueductal stenosis. VPS causes more reduction in linear indices of ventricles as compared to ETV, however, is not associated with the success or complication of the procedure.
本研究旨在比较内镜下第三脑室造瘘术（ETV）和脑室腹腔分流术（VPS）治疗因原发性导水管狭窄导致的有症状三脑室脑积水患儿的疗效。
这是一项回顾性分析研究。纳入因原发性导水管狭窄导致脑积水而首次接受ETV或VPS手术的患者。
共有89名儿童纳入本研究进行分析。平均年龄为8.4岁。44名（49.4%）首次手术为ETV，45名（50.6%）首次手术为VPS。总体而言，34名（38.2%）患者因持续性或复发性脑积水需要二次手术（ETV或VPS）。平均随访时间为832.9天。总体并发症发生率为13.5%。二次手术距首次手术的平均时间为601.35天。与二次手术相关的因素包括并发症的存在、脑脊液中蛋白含量高、额枕角比（FOHR）和埃文斯指数的相对变化。ETV组首次手术的生存期（751.55天）优于VPS组（454.49天），p = 0.013。VPS组（平均7.28%）的额枕角指数比（FOIR）相对变化高于ETV组（平均4.40%），p = 0.001。
对于因导水管狭窄导致的脑积水，ETV术后总体手术生存期优于VPS。与ETV相比，VPS导致脑室线性指标的降低更多，然而，这与手术的成功或并发症无关。
