Sudevan Kevin Jude, Konar Subhas K, Shukla Dhaval P, Sadashiva Nishanth, Nadeem Mohammed
Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India.
Childs Nerv Syst. 2025 Feb 4;41(1):103. doi: 10.1007/s00381-025-06753-0.
To evaluate the survival of endoscopic procedures performed for complex hydrocephalus, quantify clinical outcomes in standardized scales, and assess correlation with radiological outcomes using ventricular volumetry.
A retrospective analysis of patients with complex hydrocephalus, managed with neuroendoscopic procedures at a tertiary neurosurgical center over 20 years, was performed. In addition to demographic and clinical details, pre-operative and follow-up clinical status (using the Pediatric Functional Status Score (FSS) and Pediatric Cerebral Performance Category (PCPC) Scales) was assessed. Procedure failure was defined as any subsequent surgical procedure for the management of hydrocephalus and survival as time from the first endoscopic procedure to failure or last available follow-up. Ventricular volume and ventricle:brain volume ratio was calculated using serial imaging.
We analyzed 40 pediatric patients who met the study criteria with a mean age of 19 months, the most common subtype being post-meningitic multiloculated hydrocephalus (70%). The median survival of an endoscopic procedure was 24 months (5.7-33.6 months). Over a median follow-up duration of 15 months, 28 days (2.2-111 months), median FSS improved by 5 points, and median PCPC score improved from 4 (severe disability) to 3 (moderate disability). Over a median radiological follow-up of 5.9 months, the median percentage decrease in ventricle size was 27.14%, and the ventricle:brain volume ratio was 30.57%. A strong positive correlation (r = 0.58-0.75) was noted between the decrease in ventricular volume and ventricle:brain ratio with improvement in FSS and PCPC scores.
Endoscopic procedures, although effective in managing complex hydrocephalus, may not be a one-stop long-term solution, which we have described in terms of procedure survival. Objective scales and ventricular volumetry to quantify clinical and radiological improvement demonstrated a significant correlation, even in complex hydrocephalus. The potential of ventricular volumetry as a prognostic factor in complex hydrocephalus is postulated.
评估针对复杂脑积水进行的内镜手术的生存期，用标准化量表对临床结果进行量化，并使用脑室容积测量法评估与放射学结果的相关性。
对一家三级神经外科中心20年来采用神经内镜手术治疗的复杂脑积水患者进行回顾性分析。除了人口统计学和临床细节外，还评估了术前和随访时的临床状况（使用儿童功能状态评分（FSS）和儿童脑功能表现类别（PCPC）量表）。手术失败定义为随后进行的任何用于治疗脑积水的手术，生存期定义为从首次内镜手术到失败或最后一次可用随访的时间。使用系列成像计算脑室容积和脑室：脑容积比。
我们分析了40例符合研究标准的儿科患者，平均年龄为19个月，最常见的亚型是脑膜炎后多房性脑积水（70%）。内镜手术的中位生存期为24个月（5.7 - 33.6个月）。在中位随访期15个月，28天（2.2 - 111个月）内，FSS中位数提高了5分，PCPC评分中位数从4（严重残疾）提高到3（中度残疾）。在中位放射学随访期5.9个月时，脑室大小的中位百分比下降为27.14%，脑室：脑容积比为30.57%。脑室容积和脑室：脑容积比的降低与FSS和PCPC评分的改善之间存在强正相关（r = 0.58 - 0.75）。
内镜手术虽然在治疗复杂脑积水方面有效，但可能不是一个一劳永逸的长期解决方案，我们已从手术生存期方面进行了描述。用于量化临床和放射学改善情况的确观量表和脑室容积测量法显示出显著相关性，即使在复杂脑积水中也是如此。推测脑室容积测量法在复杂脑积水中作为预后因素的潜力。
