Beyond traditional predictors: the impact of the pulsatility index and cortical subarachnoid space diameter on endoscopic third ventriculostomy success.

IF 2.1 3区 医学 Q3 CLINICAL NEUROLOGY Journal of neurosurgery. Pediatrics Pub Date : 2024-09-06 Print Date: 2024-11-01 DOI:10.3171/2024.6.PEDS23560
Adrina Habibzadeh, Sina Zoghi, Ali Ansari, Sepehr Khademolhosseini, Mohammad Sadegh Masoudi, Afrooz Feili, Omid Yousefi, Reza Taheri
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引用次数: 0

Abstract

Objective: Determining the long-term success of endoscopic third ventriculostomy (ETV) remains challenging. This study aimed to investigate the impact of clinical and radiological factors on ETV success in pediatric patients with hydrocephalus.

Methods: The study included patients < 18 years old with hydrocephalus who underwent ETV between March 2014 and May 2021. Data including patient age, gender, history of previous shunt surgery, previous external ventricular drain placement, intraventricular hemorrhage history, and postoperative meningitis were extracted from medical records. Imaging features such as aqueductal stenosis, third ventricle floor bowing, displaced lamina terminalis, pulsatility index (PI), and maximum diameter of the cortical subarachnoid space (CSAS) were recorded for each patient using preoperative CT scans. Two independent neurosurgeons measured the CSAS maximum diameter and the PI. CSAS measurements were obtained on axial slices of the preoperative CT scans, whereas the PI was based on intraoperative third ventricle pulsatility. Patients were followed up for 1 year after surgery, with failure defined as the need for ventriculoperitoneal shunt (VPS) placement or death attributable to hydrocephalus.

Results: Ninety-eight children with a mean age of 16.39 ± 19.07 months underwent ETV for hydrocephalus. No deaths were recorded, but over 6 months and 1 year of follow-up, 12.2% and 22.4% of patients, respectively, experienced documented ETV failure requiring VPS placement. At the 6-month follow-up, a smaller maximum diameter of the CSAS was significantly associated with ETV failure; multivariate analysis revealed that CSAS maximum diameter was a predictor of 6-month ETV failure. At the 1-year follow-up, a lower PI was significantly associated with ETV failure, and multivariate analysis confirmed the PI as a significant predictor of ETV failure within 1 year after surgery. CSAS and PI measurements were repeated to assess interrater reliability: the intraclass correlation coefficients were 0.897 and 0.669 for CSAS and PI, respectively.

Conclusions: This study found that the CSAS maximum diameter and the PI are predictors of ETV failure at 6 months and 1 year, respectively. These findings highlight the importance of considering specific factors such as the CSAS and PI when assessing the likelihood of ETV success in pediatric patients with hydrocephalus. Further research and consideration of these factors may help optimize patient selection and improve outcomes for those undergoing ETV as a treatment for hydrocephalus.

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超越传统预测指标:搏动指数和皮质蛛网膜下腔直径对内窥镜第三脑室造口术成功率的影响。
目的:确定内镜下第三脑室造口术(ETV)的长期成功率仍具有挑战性。本研究旨在探讨儿科脑积水患者的临床和放射学因素对 ETV 成功率的影响:研究纳入了 2014 年 3 月至 2021 年 5 月间接受 ETV 的年龄小于 18 岁的脑积水患者。从病历中提取的数据包括患者的年龄、性别、既往分流手术史、既往脑室外引流管置入史、脑室内出血史和术后脑膜炎史。利用术前 CT 扫描记录了每位患者的影像学特征,如导水管狭窄、第三脑室底弓形、末端层移位、搏动指数(PI)和皮质蛛网膜下腔最大直径(CSAS)。两名独立的神经外科医生测量了 CSAS 的最大直径和 PI。CSAS 测量是通过术前 CT 扫描的轴向切片获得的,而 PI 则是根据术中第三脑室搏动率计算的。术后对患者进行为期一年的随访,失败的定义是需要进行脑室腹腔分流术(VPS)或因脑积水导致死亡:98名平均年龄为(16.39±19.07)个月的儿童接受了脑积水ETV治疗。没有死亡记录,但在6个月和1年的随访中,分别有12.2%和22.4%的患者出现有记录的ETV失败,需要植入VPS。在6个月的随访中,CSAS最大直径较小与ETV失败显著相关;多变量分析显示,CSAS最大直径是6个月ETV失败的预测因素。随访一年时,较低的 PI 与 ETV 失败显著相关,多变量分析证实 PI 是术后一年内 ETV 失败的重要预测因素。对 CSAS 和 PI 进行了重复测量,以评估相互间的可靠性:CSAS 和 PI 的类内相关系数分别为 0.897 和 0.669:本研究发现,CSAS 最大直径和 PI 分别可预测 6 个月和 1 年后 ETV 的失败。这些发现强调了在评估小儿脑积水患者 ETV 成功的可能性时考虑 CSAS 和 PI 等特定因素的重要性。对这些因素的进一步研究和考虑可能有助于优化患者选择,改善接受 ETV 治疗脑积水患者的预后。
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来源期刊
Journal of neurosurgery. Pediatrics
Journal of neurosurgery. Pediatrics 医学-临床神经学
CiteScore
3.40
自引率
10.50%
发文量
307
审稿时长
2 months
期刊介绍: Information not localiced
期刊最新文献
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