Tatoshvili Davit, Schaumann Andreas, Tietze Anna, Pennacchietti Valentina, Cohrs Gesa, Schulz Matthias, Thomale Ulrich-W
Pediatric Neurosurgery, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
Charité - Universitätsmedizin Berlin, Institute of Neuroradiology, Augustenburger Platz 1, 13353, Berlin, Germany.
Childs Nerv Syst. 2024 Dec 16;41(1):57. doi: 10.1007/s00381-024-06704-1.
Endoscopic third ventriculocisternostomy (ETV) became the relevant treatment option for non-communicating pediatric hydrocephalus. ETV success was predicted in relation to age, diagnosis, and previous shunt implantation. Radiological factors are usually taken for indication decision-making. The aim of this study is to investigate radiological signs of non-communicating hydrocephalus for ETV success in a single-center retrospective analysis.
ETV interventions were collected from a 10-year period (2010-2019) from our institution. Clinical patient characteristics such as prematurity, age, diagnosis, and previous shunt treatment and follow-up in terms of possible shunt implantation or revision surgeries were investigated. Radiological data was retrieved from the in-house PACS system to analyze preoperative signs for non-communicating hydrocephalus such as ventricular size, pressure gradients at the third ventricle, and any signs of obstruction from internal towards external cerebral spinal fluid communication. Fisher's test was used to demonstrate the significance of each individual predictor. A multivariable model was built using the backward elimination method with multiple logistic regression.
From 136 ETV interventions, 95 met the inclusion criteria (age < 18 years; > 6-month follow-up; MR image data availability, treatment goal for shunt independence). In chi-square statistical evaluation of single parameters age > 6 months (OR 32.5; 95% CI 4.8-364), ventricular width (FOHR < 0.56; OR 6.1; 95% CI 2.2-16.3) and non-post-hemorrhagic hydrocephalus as underlying diagnosis (OR 13.1; 95% CI 1.9-163) showed significant increased odds ratio for shunt independence during follow-up. Logistic regression analysis for multiple parameters showed age > 6 months (OR 29.3; 95% CI 4.1-606) together with outward bulged lamina terminalis (OR 4.6; 95% CI 1.2-19.6), smaller FOHR (continuous parameter; OR 2.83 × 10; 95% CI 4.7 × 10-0.045), and non-4th-ventricular-outlet obstruction (4thVOO; OR 0.31; 95% CI 0.09-1.02) as significant factors for ETV success.
ETV has become a relevant treatment for non-communicating hydrocephalus, with typical MR image characteristics. Analyzing radiological markers as predictors for success smaller ventricular width and outward displaced lamina terminalis was relevant in combination with age > 6 months. Since the analysis is based on single-center experience, a larger cohort of patients with a multi-center approach should further investigate the combined clinical and radiological criteria.
内镜下第三脑室造瘘术（ETV）已成为治疗非交通性小儿脑积水的相关治疗选择。ETV的成功与否与年龄、诊断及既往分流植入情况有关。通常依据影像学因素来决定手术指征。本研究旨在通过单中心回顾性分析，探究非交通性脑积水患者ETV成功的影像学征象。
收集我院10年期间（2010 - 2019年）的ETV干预病例。调查临床患者特征，如早产情况、年龄、诊断、既往分流治疗情况以及后续可能的分流植入或翻修手术情况。从医院内部的PACS系统获取影像学数据，分析非交通性脑积水的术前征象，如脑室大小、第三脑室压力梯度以及从脑室内向脑室外脑脊液通路的任何梗阻迹象。采用Fisher检验来证明每个单独预测因素的显著性。使用向后排除法和多元逻辑回归建立多变量模型。
在136例ETV干预病例中，95例符合纳入标准（年龄<18岁；随访>6个月；有磁共振成像数据；目标为实现分流独立）。在单参数的卡方统计评估中，年龄>6个月（OR 32.5；95%CI 4.8 - 364）、脑室宽度（FOHR<0.56；OR 6.1；95%CI 2.2 - 16.3）以及潜在诊断为非出血性脑积水（OR 13.1；95%CI 1.9 - 163）在随访期间显示出分流独立的优势比显著增加。多参数逻辑回归分析显示，年龄>6个月（OR 29.3；95%CI 4.1 - 606）、终板向外膨出（OR 4.6；95%CI 1.2 - 19.6）、较小的FOHR（连续参数；OR 2.83×10；95%CI 4.7×10 - 0.045）以及非第四脑室出口梗阻（4thVOO；OR 0.31；95%CI 0.09 - 1.02）是ETV成功的显著因素。
ETV已成为治疗非交通性脑积水的相关治疗方法，具有典型的磁共振成像特征。将较小的脑室宽度和向外移位的终板作为成功的预测影像学标志物，并结合年龄大于6个月进行分析具有重要意义。由于该分析基于单中心经验，采用多中心方法纳入更大队列的患者应进一步研究临床和影像学联合标准。
