Pištěk Karel, Sameš Martin, Radovnický Tomáš
Second Faculty of Medicine, Charles University, Prague, Czech Republic.
Neurosurgical Department, J.E. Purkynje University, Masaryk Hospital Krajská Zdravotní a.s., Ústí nad Labem, Czech Republic.
Brain Spine. 2025 Jul 7;5:104311. doi: 10.1016/j.bas.2025.104311. eCollection 2025.
Current best practice for the treatment of idiopathic normal pressure hydrocephalus (iNPH) involves ventriculoperitoneal shunt implantation, which is associated with several long-term complications. Throughout the last two decades endoscopic third ventriculostomy (ETV) has emerged as an alternate therapeutic modality. This modality promises a lower incidence of surgical and postoperative complications. This review focuses on patients with iNPH treated via ETV, compares the efficacy of ETV between individual studies and summarizes predictive measures of ETV success.
The development of the protocol was guided by the Preferred Reporting Items for Systematic Review and MetaAnalysis Protocols 2015 statement. Relevant literature was selected using complex registers and in several bibliographical databases. A total of 17 original articles comparing the efficacy of ETV were selected for the review, 12 of which were used to analyze positive predictors of ETV therapy.
A total of 282 patients with iNPH underwent ETV, with an average efficacy 63.7 %. Positive predictors of ETV treatment were the presence of pathological outflow resistance (R) in the ventricular compartment during cerebrospinal fluid (CSF) dynamic tests, hyperdynamic CSF flow, functional stenosis of the Sylvian aqueduct and/or bowing of the third ventricle on magnetic resonance imaging (MRI). Further positive predictors included short duration of symptoms and a predominantly gait-centric clinical presentation.
Endoscopic treatment of patients with iNPH remains controversial and shunt surgery remains the treatment of choice. The analyzed studies show that a subset of patients profit from ETV. Further studies with robust randomized cohorts comparing ETV to shunting are necessary.
特发性正常压力脑积水（iNPH）的当前最佳治疗方法是脑室腹腔分流术植入，但该方法存在多种长期并发症。在过去二十年中，内镜下第三脑室造瘘术（ETV）已成为一种替代治疗方式。这种方式有望降低手术及术后并发症的发生率。本综述聚焦于接受ETV治疗的iNPH患者，比较各研究中ETV的疗效，并总结ETV成功的预测指标。
该方案的制定遵循《系统评价与Meta分析方案的首选报告项目（PRISMA）2015声明》。通过综合检索工具及多个书目数据库筛选相关文献。共选择17篇比较ETV疗效的原始文章进行综述，其中12篇用于分析ETV治疗的阳性预测指标。
共有282例iNPH患者接受了ETV治疗，平均有效率为63.7%。ETV治疗的阳性预测指标包括脑脊液（CSF）动态测试时脑室系统存在病理性流出阻力（R）、CSF流动活跃、磁共振成像（MRI）显示大脑中脑导水管功能性狭窄和/或第三脑室受压。其他阳性预测指标包括症状持续时间短以及以步态为主的临床表现。
内镜治疗iNPH患者仍存在争议，分流手术仍是首选治疗方法。分析研究表明，一部分患者可从ETV中获益。有必要开展更有力的随机队列研究，比较ETV与分流术的效果。
