Cerebrospinal fluid alterations following endoscopic third ventriculostomy with choroid plexus cauterization: a retrospective laboratory analysis of two tertiary care centers
Cerebrospinal fluid alterations following endoscopic third ventriculostomy with choroid plexus cauterization: a retrospective laboratory analysis of two tertiary care centers
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DOI：
10.1007/s00381-019-04415-6
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发表时间：
2019-11
期刊：
影响因子：
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通讯作者：
M. Dewan;Jonathan Dallas;Shilin Zhao;Burkely P. Smith;Stephen R. Gannon;Fakhry M. Dawoud;Heidi Chen;C. Shannon;B. Rocque;R. Naftel
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文献类型：
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作者：
M. Dewan;Jonathan Dallas;Shilin Zhao;Burkely P. Smith;Stephen R. Gannon;Fakhry M. Dawoud;Heidi Chen;C. Shannon;B. Rocque;R. Naftel
目的：本研究旨在确定内镜下第三脑室造瘘伴脉络膜丛烧灼术（ETV/CPC）的细胞学和代谢改变。方法对婴儿脑积水患者在ETV/CPC指数时采集脑脊液，对持续性脑积水患者在每次再干预时采集脑脊液。记录脑脊液基本参数，包括葡萄糖、蛋白和细胞计数。为每个参数构建了一个多变量回归模型，其中包含已知的ETV/CPC结果预测因子，以告知随时间变化的规范值。结果经ETV/CPC治疗脑积水患儿187例；164例患者可获得初始实验室值。脑积水的病因包括髓脊膜膨出（53,32%）、早产儿脑室内出血（43,26%）、导水管狭窄（24.15%）和其他（44.27%）。脑脊液参数与年龄或病因无显著差异。术后血糖水平最初低于人群平均水平（36 ~ 32 mg/dL）， 3个月后缓慢上升至正常水平（42 mg/dL）。etv /CPC后显著升高的蛋白质水平（基线为59 mg/dL， 1个月时约为200 mg/dL）也在3个月内正常化。WBC未见明显变化。红细胞计数在ETV/CPC后非常高，并在随后的一个月内迅速下降。结论经ETV/CPC术后3个月，脑脊液葡萄糖和蛋白明显偏离正常值。高RBC值立即在etv /CPC后迅速下降。手术年龄和病因对临床常见脑脊液实验室参数影响不大。值得注意的是，回顾性研究设计需要ETV/CPC失败，这可能会导致结果偏倚。
PurposeThis study sought to determine the previously undescribed cytologic and metabolic alterations that accompany endoscopic third ventriculostomy with choroid plexus cauterization (ETV/CPC).MethodsCerebrospinal fluid (CSF) samples were collected from infant patients with hydrocephalus at the time of index ETV/CPC and again at each reintervention for persistent hydrocephalus. Basic CSF parameters, including glucose, protein, and cell counts, were documented. A multivariable regression model, incorporating known predictors of ETV/CPC outcome, was constructed for each parameter to inform time-dependent normative values.ResultsA total of 187 infants were treated via ETV/CPC for hydrocephalus; initial laboratory values were available for 164 patients. Etiology of hydrocephalus included myelomeningocele (53, 32%), intraventricular hemorrhage of prematurity (43, 26%), aqueductal stenosis (24, 15%), and others (44, 27%). CSF parameters did not differ significantly with age or etiology. Glucose levels initially drop below population average (36 to 32 mg/dL) post-operatively before slowly rising to normal levels (42 mg/dL) by 3 months. Dramatically elevated protein levels post-ETV/CPC (baseline of 59 mg/dL up to roughly 200 mg/dL at 1 month) also normalized over 3 months. No significant changes were appreciated in WBC. RBC counts were very elevated following ETV/CPC and quickly declined over the subsequent month.ConclusionCSF glucose and protein deviate significantly from normal ranges following ETV/CPC before normalizing over 3 months. High RBC values immediately post-ETV/CPC decline rapidly. Age at time of procedure and etiology have little influence on common clinical CSF laboratory parameters. Of note, the retrospective study design necessitates ETV/CPC failure, which could introduce bias in the results.