Departments of Neurological Surgery, University of Wisconsin, Madison, WI, USA.
Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI, USA.
Childs Nerv Syst. 2024 Aug;40(8):2401-2409. doi: 10.1007/s00381-024-06399-4. Epub 2024 May 3.
CSF shunt placement for hydrocephalus and other etiologies has arguably been the most life-saving intervention in pediatric neurosurgery in the past 6 decades. Yet, chronic shunting remains a source of morbidity for patients of all ages. Neuroendoscopic surgery has made shunt independence possible for newly diagnosed hydrocephalic patients. In this study, we examine the prospects of shunt independence with or without endoscopic third ventriculostomy (ETV) in chronically shunted patients.
After IRB approval, a retrospective analysis was completed on patients whose shunt was ligated or removed to achieve shunt independence, with or without ETV. Clinical and imaging data were collected.
Eighty-eight patients with CSF shunts had their shunt either ligated or removed, 57 of whom had a concomitant ETV. Original reasons for shunting included: congenital hydrocephalus 20 (23%), post-hemorrhagic hydrocephalus (PHH) of prematurity 14 (16%), aqueductal stenosis 10 (11%), intracranial cyst 8 (9%), tumor 8 (9%), infantile subdural hematomas 8 (9%), myelomeningocele 7 (8%), post-traumatic hydrocephalus 7 (8%) and post-infectious hydrocephalus 6 (7%). The decision to perform a simultaneous ETV was made based on etiology. Forty-nine (56%) patients became shunt independent. The success rate was 46% in the ETV group and 73% in the no ETV group. Using multivariate analysis and Cox Proportional Hazards models, age > 4 months at shunt placement (p = 0.032), no shunt revisions (p = 0.01), select etiologies (p = 0.043), and ETVSS > 70 (in the ETV group) (p = 0.017), were protective factors for shunt independence.
Considering the long-term complications of shunting, achieving shunt independence may provide hope for improved quality of life. While this study is underpowered, it provides pilot data identifying factors that predict shunt independence in chronically shunted patients, namely age, absence of prior shunt revision, etiology, and in the ETV group, the ETVSS.
在过去的 60 年中，CSF 分流术治疗脑积水和其他病因的脑积水可以说是儿科神经外科最具救命意义的干预措施。然而，慢性分流仍然是所有年龄段患者发病的根源。神经内镜手术使新诊断为脑积水的患者有可能实现分流术独立。在这项研究中，我们研究了伴有或不伴有内镜第三脑室造瘘术（ETV）的慢性分流患者实现分流术独立的前景。
在获得机构审查委员会批准后，我们对接受分流管结扎或拔除以实现分流术独立的患者进行了回顾性分析，这些患者伴有或不伴有 ETV。收集了临床和影像学数据。
88 例 CSF 分流患者的分流管被结扎或拔除，其中 57 例同时进行了 ETV。分流的最初原因包括：先天性脑积水 20 例（23%），早产儿出血后脑积水（PHH）14 例（16%），中脑导水管狭窄 10 例（11%），颅内囊肿 8 例（9%），肿瘤 8 例（9%），婴儿硬膜下血肿 8 例（9%），脊髓脊膜膨出 7 例（8%），创伤后脑积水 7 例（8%）和感染后脑积水 6 例（7%）。是否同时进行 ETV 是基于病因决定的。49 例（56%）患者实现了分流术独立。ETV 组的成功率为 46%，无 ETV 组为 73%。使用多变量分析和 Cox 比例风险模型，分流时年龄＞4 个月（p=0.032）、无分流管再调整（p=0.01）、选择特定病因（p=0.043）和 ETVSS＞70（ETV 组）（p=0.017）是实现分流术独立的保护因素。
考虑到分流术的长期并发症，实现分流术独立可能为改善生活质量带来希望。虽然本研究的效力不足，但它提供了一些初步数据，确定了预测慢性分流患者分流术独立的因素，即年龄、无先前的分流管再调整、病因以及在 ETV 组中，ETVSS。
