Reopening of an obstructed third ventriculostomy: long-term success and factors affecting outcome in 215 infants
Reopening of an obstructed third ventriculostomy: long-term success and factors affecting outcome in 215 infants
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DOI：
10.3171/2014.10.peds14250
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发表时间：
2015-04-01
影响因子：
1.9
通讯作者：
Warf, Benjamin C.
中科院分区：
文献类型：
--
作者：
Marano, Paul J.;Stone, Scellig S. D.;Warf, Benjamin C.
目的重新开放梗阻的内镜下第三脑室造瘘术（ETV）作为ETV失败的治疗方法的作用还不明确。作者研究了215名ETV闭合成功的儿童，他们接受了成功的重复ETV，以确定适应症，长期成功率和影响结局的因素。方法作者回顾性回顾了2001年8月至2012年12月乌干达CURE儿童医院数据库，确定了215名ETV失败的儿童（有或没有先前的脉络丛烧灼[CPC]），他们接受了阻塞的ETV造口的重新开放。根据性别、首次和第二次手术时的年龄、首次手术失败时间、脑积水病因、既往CPC和ETV阻塞模式（单纯造口闭合、第二膜或蛛网膜瘢痕引起的脑池阻塞），使用Kaplan-Meier生存法评估治疗生存率。使用对数秩和Wilcoxon方法和一个考克斯比例风险model.Results组间生存差异进行了评估，有125名男孩和90名女孩的平均年龄和中位数分别为229和92天，在最初的ETV。重复ETV的平均和中位年龄分别为347天和180天。感染后脑积水（PIH）为126例患者的病因，非感染后脑积水（NPIH）为89例。总体估计重复ETV的7年成功率为51%。性别（p = 0.46，对数秩检验; p = 0.54，Wilcoxon检验）、< vs >初始或重复ETV时的年龄（6个月）（初始p = 0.08，重复p = 0.13;对数秩检验）和ETV阻塞类型（p = 0.61，对数秩检验）不影响重复ETV的结局（p值>= 0.05，考克斯回归）。初始ETV失败时间较长的患者（> 6个月91%，3-6个月60%，
OBJECT The role of reopening an obstructed endoscopic third ventriculostomy (ETV) as treatment for ETV failure is not well defined. The authors studied 215 children with ETV closure who underwent successful repeat ETV to determine the indications, long-term success, and factors affecting outcome.METHODS The authors retrospectively reviewed the CURE Children's Hospital of Uganda database from August 2001 through December 2012, identifying 215 children with failed ETV (with or without prior choroid plexus cauterization [CPC]) who underwent reopening of an obstructed ETV stoma. Treatment survival according to sex, age at first and second operation, time to failure of first operation, etiology of hydrocephalus, prior CPC, and mode of ETV obstruction (simple stoma closure, second membrane, or cisternal obstruction from arachnoid scarring) were assessed using the Kaplan-Meier survival method. Survival differences among groups were assessed using log-rank and Wilcoxon methods and a Cox proportional hazards model.RESULTS There were 125 boys and 90 girls with mean and median ages of 229 and 92 days, respectively, at the initial ETV. Mean and median ages at repeat ETV were 347 and 180 days, respectively. Postinfectious hydrocephalus (PIH) was the etiology in 126 patients, and nonpostinfectious hydrocephalus (NPIH) in 89. Overall estimated 7-year success for repeat ETV was 51%. Sex (p = 0.46, log-rank test; p = 0.54, Wilcoxon test), age (< vs > 6 months) at initial or repeat ETV (p = 0.08 initial, p = 0.13 repeat; log-rank test), and type of ETV obstruction (p = 0.61, log-rank test) did not affect outcome for repeat ETV (p values >= 0.05, Cox regression). Those with a longer time to failure of initial ETV (> 6 months 91%, 3-6 months 60%,