Sohail Ayesha, Bajwa Mohammad Hamza, Virani Qurat-Ul-Ain, Tariq Anam, Hussain Nasr, Shamim Shahzad M
Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
Surg Neurol Int. 2024 May 10;15:154. doi: 10.25259/SNI_127_2024. eCollection 2024.
Endoscopic third ventriculostomy (ETV) is considered an alternative treatment for hydrocephalus and has become a standard of care for obstructive hydrocephalus. Recent studies have also explored its role in normal pressure hydrocephalus (NPH). We conducted a systematic review aiming to assess the outcomes of this minimally invasive endoscopic technique as a viable treatment option for NPH.
A systematic literature search was performed using PubMed and Scopus databases, using iterations of search terms "Endoscopic third ventriculostomy," "Idiopathic normal pressure hydrocephalus," and "Normal pressure hydrocephalus." To be eligible for inclusion in the review, articles had to report the usage of ETV as a primary treatment modality for NPH, report its outcomes, and be published in the English language.
Out of the 13 studies selected for qualitative synthesis, nine supported the use of ETV for NPH as an effective treatment option with improvement in the preoperative symptoms. Two studies favored shunt over ETV, stating that quality of life is better with VP shunt insertion. One study reported that ETV has higher perioperative mortality rates that outweigh its benefits. One study reported it to be an ineffective surgical option.
The current review of evidence does not support the use of ETV for the treatment of NPH, except perhaps in a small subset of patients. These patients have a shorter duration of symptoms and a better preoperative neurological status. The lumbar infusion test and ventricular infusion test are modalities useful for selecting these candidates.
内镜下第三脑室造瘘术（ETV）被认为是脑积水的一种替代治疗方法，已成为梗阻性脑积水的标准治疗手段。近期研究也探讨了其在正常压力脑积水（NPH）中的作用。我们进行了一项系统评价，旨在评估这种微创内镜技术作为NPH可行治疗选择的疗效。
使用PubMed和Scopus数据库进行系统文献检索，搜索词包括“内镜下第三脑室造瘘术”“特发性正常压力脑积水”和“正常压力脑积水”。要纳入本评价，文章必须报告ETV作为NPH主要治疗方式的使用情况、报告其疗效且以英文发表。
在选入定性分析的13项研究中，9项支持将ETV用于NPH，认为其是一种有效的治疗选择，可改善术前症状。2项研究更倾向于分流术而非ETV，称行脑室腹腔分流术时生活质量更好。1项研究报告ETV围手术期死亡率较高，其风险超过益处。1项研究报告其为无效的手术选择。
目前的证据评价不支持将ETV用于治疗NPH，可能少数患者除外。这些患者症状持续时间较短且术前神经状态较好。腰椎灌注试验和脑室灌注试验有助于筛选这些患者。
