Krause Matthias, Gräfe Daniel, Metzger Roman, Griessenauer Christoph J, Gburek-Augustat Janina
Department for Neurosurgery, Christian-Doppler-Klinik, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria.
Department of Pediatric Surgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria.
Childs Nerv Syst. 2024 Dec 28;41(1):72. doi: 10.1007/s00381-024-06728-7.
Endoscopic Third Ventriculostomy (ETV) is a well-established treatment for pediatric hydrocephalus, particularly in cases of aqueductal stenosis. The ETV Success Score (ETVSS) is a predictive tool widely used to estimate the likelihood of ETV success based on factors like age. Its accuracy, especially in infants under 3 months, is still debated.
This study evaluates the age-dependency of ETV success in 54 pediatric patients compared to ETVSS predictions. Patients were divided into age and pathology groups according to Kulkarni. Success was defined according the ETVSS criteria. Minimum follow-up was 12 months and included MRI to demonstrate a flow void at the floor or the third ventricle.
Our institutional data revealed a higher overall success rate SR (88%) compared to the ETVSS-predicted rate of 73%. Despite small numbers within subgroups, especially in very young children < 1 month, the success rate was higher than predicted by ETVSS.
Our results show significantly higher actual SR across all age groups compared to ETVSS predictions (p = 0.035) when selected and performed by an experienced physician. The age groups > 1 year had significantly higher SR close to 100% (p < 0.0001 and p = 0.0038, respectively). This suggests that ETV may be underutilized, particularly in infants, where predicted success rates are pessimistic.
ETVSS is a useful tool for counseling of parents, but differences in institution-specific outcomes should not be neglected. Depending on that, physicians might opt in favor of ETV as primary treatment in occlusive hydrocephalus of very young children, counterbalancing risks and sequalae of VP-shunting.
内镜下第三脑室造瘘术（ETV）是治疗小儿脑积水的一种成熟方法，尤其适用于导水管狭窄的病例。ETV成功评分（ETVSS）是一种广泛使用的预测工具，用于根据年龄等因素估计ETV成功的可能性。其准确性，尤其是在3个月以下婴儿中的准确性，仍存在争议。
本研究评估了54例儿科患者中ETV成功的年龄依赖性，并与ETVSS预测结果进行比较。根据卡尔卡尼的方法，将患者分为年龄和病理组。成功的定义依据ETVSS标准。最短随访时间为12个月，包括MRI以显示第三脑室底部的血流空洞。
我们机构的数据显示，总体成功率（SR）为88%，高于ETVSS预测的73%。尽管亚组内数量较少，尤其是在1个月以下的幼儿中，但成功率高于ETVSS的预测值。
我们的结果显示，由经验丰富的医生选择并实施时，所有年龄组的实际成功率均显著高于ETVSS预测值（p = 0.035）。1岁以上年龄组的成功率显著更高，接近100%（分别为p < 0.0001和p = 0.0038）。这表明ETV的应用可能不足，尤其是在婴儿中，其预测成功率较为悲观。
ETVSS是向家长提供咨询的有用工具，但不应忽视机构特定结果的差异。据此，医生可能会选择将ETV作为幼儿梗阻性脑积水的主要治疗方法，以平衡脑室腹腔分流术的风险和后遗症。
