小儿脑积水治疗后一年死亡率：内镜下第三脑室造瘘术与脑室腹腔分流术的对比分析

One year mortality after pediatric hydrocephalus treatment: a comparative analysis of endoscopic third ventriculostomy and ventriculoperitoneal shunt.

作者信息

Alali Ahmad, Alkabouni Wesam, Aretz Viktoria, Volpert Timo, Makanjira Yollam, Kampeni Martin, Kapapa Thomas, Kamalo Patrick

机构信息

Department of Neurosurgery, Ulm University Hospital, Ulm, Germany.

Blantyre Institute of Neurosurgical Sciences, Blantyre, Malawi.

出版信息

Front Surg. 2025 May 22;12:1538899. doi: 10.3389/fsurg.2025.1538899. eCollection 2025.

DOI:10.3389/fsurg.2025.1538899

PMID:40476054

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12137355/

Abstract

BACKGROUND

Management options for hydrocephalus have increased to include endoscopic third ventriculostomy with or without choroid plexus cauterization (ETV ± CPC) in addition to traditional ventrikuloperitoneal shunting (VPS). This study evaluates the mortality and complications of these procedures in pediatric hydrocephalus, offering insights for clinical decision-making in a low-income country context.

METHODS

We retrospectively reviewed the operating theatre registry for infants under 1 year of age who underwent initial hydrocephalus surgery in a tertial sub-Saharan hospital in 2021. Follow-up was conducted for up to 1 year after surgery, confirming the patient's vital status (alive or dead) through hospital visits, contact information, and medical records. Descriptive analyses evaluated outcomes (mortality and complications), and survival was assessed using the Kaplan-Meier method with log-rank testing.

RESULTS

A total of 127 patients were included, with 71 males (55.91%). Complete 1-year follow-up data was available for 94 (74%) patients. Of these, 35 (37.23%) underwent ETV ± CPC and 59 (62.77%) underwent VPS. The one-year survival rate was 80% (95% CI: 66.75%-93.25%) for those treated with ETV ± CPC as a definitive treatment and 78% (95% CI: 67.43%-88.57%) for those who received VPS. There was no statistically significant difference in survival rates between the two groups (Log-Rank test = 0.809). Shunt sepsis occurred in 6 patients (10.16%, 95% CI: 2.45%-17.87%). The majority of surgical complications occurred within the first 3 months following surgery, including shunt dysfunction in 4 VPS patients (6.7%, 95% CI: 0.32%-13.08%) and failed ETV in 10 patients (22.2%, 95% CI: 8.43%-35.97%) of those who underwent primary ETV.

CONCLUSION

ETV ± CPC and VPS demonstrated similar survival rates, with no significant statistical difference between the two methods. However, ETV ± CPC failure often required conversion to VPS, highlighting the importance of managing shunt-related complications like sepsis and dysfunction. Careful post-operative monitoring is essential for both procedures.

摘要

背景

脑积水的治疗选择有所增加，除了传统的脑室腹腔分流术（VPS）外，还包括内镜下第三脑室造瘘术（有或无脉络丛烧灼术，即ETV±CPC）。本研究评估了这些手术在小儿脑积水中的死亡率和并发症，为低收入国家背景下的临床决策提供见解。

方法

我们回顾性分析了2021年在撒哈拉以南非洲一家三级医院接受初次脑积水手术的1岁以下婴儿的手术室登记资料。术后进行了长达1年的随访，通过医院就诊情况以及联系信息和病历确认患者的生命状态（存活或死亡）。描述性分析评估了结局（死亡率和并发症），并使用Kaplan-Meier方法和对数秩检验评估生存率。

结果

共纳入127例患者，其中男性71例（55.91%）。94例（74%）患者获得了完整的1年随访数据。其中，35例（37.23%）接受了ETV±CPC手术，59例（62.77%）接受了VPS手术。作为确定性治疗接受ETV±CPC的患者1年生存率为80%（95%可信区间：66.75%-93.25%），接受VPS的患者为78%（95%可信区间：67.43%-88.57%）。两组生存率无统计学显著差异（对数秩检验=0.809）。6例患者（10.16%，95%可信区间：2.45%-17.87%）发生分流感染。大多数手术并发症发生在术后前3个月内，包括4例VPS患者出现分流功能障碍（6.7%，95%可信区间：0.32%-13.08%），以及接受初次ETV手术的患者中有10例（22.2%，95%可信区间：8.43%-35.97%）ETV手术失败。