Quality of life after endoscopic third ventriculostomy and cerebrospinal fluid shunting: an adjusted multivariable analysis in a large cohort Clinical article
Quality of life after endoscopic third ventriculostomy and cerebrospinal fluid shunting: an adjusted multivariable analysis in a large cohort Clinical article
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DOI：
10.3171/2010.3.peds09358
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发表时间：
2010-07-01
影响因子：
1.9
通讯作者：
McNeely, P. Daniel
中科院分区：
文献类型：
--
作者：
Kulkarni, Abhaya V.;Shams, Iffat;McNeely, P. Daniel
目的。比较内镜第三脑室造口术 (ETV) 和脑脊液分流治疗的生活质量 (QOL) 研究非常有限。作者通过使用多变量统计技术来调整可能的混杂变量，比较了一大群脑积水儿童接受这两种治疗后的生活质量结果。方法。在加拿大 3 个儿科神经外科中心接受过脑积水治疗的 5 至 18 岁儿童的家庭完成了生活质量测量：脑积水结果问卷 (HOQ) 和健康公用事业指数标记 3 (HUI3)。回顾了医疗记录和最近的脑成像研究。以 QOL 测量作为因变量进行线性回归分析。在多变量分析中，作者评估了初始脑积水治疗（ETV 与分流）的独立效果，同时调整治疗中心、当前患者年龄、初始治疗年龄、脑积水病因、初始治疗住院总天数、随后脑积水并发症住院总天数、随访评估时功能性 ETV、癫痫发作频率和当前心室大小。结果。 603 名患者的数据可供分析。 58 名患者接受了 ETV 作为主要治疗，545 名患者接受了脑脊液分流术。内镜下第三脑室造口术患者在随访评估中年龄稍小，第一次手术时年龄较大，并且因脑积水并发症住院天数较少。在不调整任何混杂因素的情况下，ETV 治疗与显着较高的 HOQ 身体评分和 HUI3 评分相关。然而，经过多变量调整后，任何结果指标都没有显着差异。在任何模型中，后续评估时有效的 ETV 都不显着。结论。在调整预后因素后，ETV 或 CSF 分流治疗似乎与 QOL 结果没有任何实质性差异相关。需要进一步研究来明确确定任一手术的相对生活质量益处（如果有）。 （DOI：10.317112010.3.PEDS09358）
Object. Quality of life (QOL) studies comparing treatment with endoscopic third ventriculostomy (ETV) and CSF shunting are very limited. The authors compared QOL outcomes following these 2 treatments in a large cohort of children with hydrocephalus by using multivariable statistical techniques to adjust for possible confounder variables.Methods. The families of children between 5 and 18 years of age with previously treated hydrocephalus at 3 Canadian pediatric neurosurgery centers completed measures of QOL: the Hydrocephalus Outcome Questionnaire (HOQ) and the Health Utilities Index Mark 3 (HUI3). Medical records and recent brain imaging studies were reviewed. A linear regression analysis was performed with the QOL measures as the dependent variable. In multivariable analyses, the authors assessed the independent effect of initial hydrocephalus treatment (ETV vs shunting) while adjusting for the treatment center, current patient age, age at initial treatment, etiology of hydrocephalus, total number of days spent in the hospital for initial treatment, total number of days spent in the hospital for subsequent hydrocephalus complications, functioning ETV at follow-up assessment, frequency of seizures, and current ventricle size.Results. Data from 603 patients were available for analysis. Fifty-eight patients had undergone ETV as their primary treatment and 545 had undergone CSF shunting. Endoscopic third ventriculostomy patients were slightly younger at the follow-up assessment, were older at the first surgery, and spent fewer days in the hospital for hydrocephalus complications. Without adjustment for any confounders, treatment with ETV was associated with significantly higher HOQ physical scores and HUI3 scores. After multivariable adjustment, however, there was no significant difference in any outcome measure. A functioning ETV at the time of the follow-up assessment was not significant in any model.Conclusions. Treatment with either ETV or CSF shunting does not appear to be associated with any substantial difference in QOL outcome after adjusting for prognostic factors. Further study is needed to definitively determine the relative QOL benefit of either procedure, if any. (DOI: 10.317112010.3.PEDS09358)