Departments of Neurosurgery and Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.
Pediatric Neurosurgery, Charité Universitaetsmedizin Berlin, Berlin, Germany.
Childs Nerv Syst. 2024 Oct;40(10):2995-3000. doi: 10.1007/s00381-024-06566-7. Epub 2024 Aug 5.
Endoscopic third ventriculostomy (ETV) is an effective treatment for obstructive hydrocephalus. Secondary stoma closure may be life threatening and is the most common reason for late ETV failure, mostly secondary to local scarring. Local stents intended to maintain patency are rarely used. In this study, we summarize our experience using stented ETV (sETV), efficacy, and safety.
Data was retrospectively collected from all consecutive patients who underwent ETV with stenting at four centers. Collected data included indications for using sETV, hydrocephalic history, surgical technique, outcomes, and complications.
Sixty-seven cases were included. Forty had a primary sETV, and 27 had a secondary sETV (following a prior shunt, ETV, or both). The average age during surgery was 22 years. Main indications for sETV included an adjacent tumor (n = 15), thick or redundant tuber cinereum (n = 24), and prior ETV failure (n = 16). Fifty-nine patients (88%) had a successful sETV. Eight patients failed 11 ± 8 months following surgery. Reasons for failure included obstruction of the stent, reabsorption insufficiency, and CSF leak (n = 2 each), and massive hygroma and tumor spread (n = 1 each). Complications included subdural hygroma (n = 4), CSF leak (n = 2), and stent malposition (n = 1). There were no complications associated with two stent removals.
Stented ETV appears to be feasible and safe. It may be indicated in selected cases such as patients with prior ETV failure, or as a primary treatment in cases with anatomical alterations caused by tumors or thickened tuber cinereum. Future investigations are needed to further elucidate its role in non-communicating hydrocephalus.
内镜第三脑室造瘘术（ETV）是治疗梗阻性脑积水的有效方法。继发的造瘘口关闭可能危及生命，是 ETV 术后晚期失败的最常见原因，主要继发于局部瘢痕形成。很少使用旨在保持通畅的局部支架。在本研究中，我们总结了使用支架的 ETV（sETV）的经验、疗效和安全性。
从四个中心的所有连续接受 ETV 支架置入术的患者中回顾性收集数据。收集的数据包括使用 sETV 的适应证、脑积水病史、手术技术、结果和并发症。
共纳入 67 例患者。40 例行原发性 sETV，27 例行继发性 sETV（继分流术后、ETV 术后或两者之后）。手术时的平均年龄为 22 岁。sETV 的主要适应证包括邻近肿瘤（n=15）、厚或多余的灰结节（n=24）和既往 ETV 失败（n=16）。59 例（88%）患者 sETV 成功。术后 11±8 个月 8 例患者失败。失败的原因包括支架阻塞、吸收不足和 CSF 漏（各 2 例）、大量硬膜下积气和肿瘤扩散（各 1 例）。并发症包括硬膜下积气（n=4）、CSF 漏（n=2）和支架位置不当（n=1）。两次支架取出均无并发症。
支架的 ETV 似乎是可行和安全的。在某些情况下，如既往 ETV 失败的患者，或在由肿瘤或增厚的灰结节引起的解剖改变的情况下，作为原发性治疗方法，可能是可行的。需要进一步的研究来进一步阐明其在非交通性脑积水中的作用。
