胎儿脊髓膜膨出修补术后的脑积水治疗:比较内窥镜第三脑室造口术和脉络丛烧灼术与脑室分流术。

IF 2.1 3区 医学 Q3 CLINICAL NEUROLOGY Journal of neurosurgery. Pediatrics Pub Date : 2024-06-21 Print Date: 2024-09-01 DOI:10.3171/2024.5.PEDS24171
Justine Izah, Joseline Haizel-Cobbina, Shilin Zhao, E Haley Vance, Michelle Dunlap, Stephen R Gannon, Campbell Liles, Aaron M Yengo-Kahn, Matthew E Pontell, Robert P Naftel, John C Wellons, Michael C Dewan
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引用次数: 0

摘要

研究目的本研究旨在比较通过脑室腹腔分流术(VPS)或内镜下第三脑室造口术联合脉络丛烧灼术(ETV/CPC)进行胎儿脊髓膜膨出修补术(fMMR)后脑积水患者的临床和头颅测量结果:这是一项回顾性队列研究,研究对象是2012年至2021年期间在范德比尔特接受FMMR治疗后,通过VPS或ETV(带或不带CPC)(ETV ± CPC)进行脑积水治疗的儿童。主要结果是治疗失败和治疗失败时间 (TTF)。次要结果包括脑积水指标的变化(前枕骨角比 [FOHR] 和头围测量值)和医疗资源利用率(入院次数、门诊次数和神经影像学检查结果):在 88 名接受 fMMR 的患者中,37 人(42%)需要永久性 CSF 转移,其中 19 人在作者所在机构接受了治疗。12名患者接受了ETV±CPC治疗,7名患者接受了VPS置入治疗,中位矫正年龄分别为23周和1周(P = 0.002)。ETV ± CPC队列患者的术前中位头围百分位数和z-分数与VPS队列相似(百分位数:98.5 vs 94.0,p = 0.064;z-分数:2.32 vs 1.60,p = 0.111)。两组患者术前的中位 FOHR 测量值没有差异(0.57 vs 0.59,p = 0.53)。术后 6 个月,ETV ± CPC 组群的中位头部周长百分位数和 Z 值在两组之间保持相似(百分位数:98.0 vs 67.5,p = 0.315;Z 值:2.12 vs 0.52,p = 0.307)。在指数 CSF 转移术后 6 个月,两组患者的 FOHR 变化(-0.06 vs -0.09,p = 0.37)和头围百分位数变化(-1.33 vs -28.6,p = 0.058)没有差异。ETV ± CPC组别中有一名患者术后出现癫痫发作和非手术硬膜下出血,未观察到其他并发症。VPS 组群的 7 名患者中有 6 名需要进行分流术翻修,中位 TTF 为 9.8 个月,而 12 名 ETV ± CPC 患者中有 2 名需要再次进行 ETV,中位时间为 17.5 个月(86% vs 17%,P = 0.013)。ETV ± CPC队列中与脑积水相关的再住院中位数明显低于VPS队列(0 vs 1,p = 0.006)。ETV ± CPC队列的CT扫描次数(0 vs 2,p = 0.004)和X光检查次数(0 vs 2,p < 0.001)均少于VPS队列:结论:在单中心队列中,通过 ETV ± CPC 治疗的颅脑积水 fMMR 患者仍无分流,而大多数接受前期分流的患者需要进行翻修。这是第一项在 fMMR 脑积水患者中比较 ETV ± CPC 与 VPS 的研究。虽然还需要更大规模的多中心研究,但这些结果表明,ETV/CPC 可能是 fMMR 后 CSF 分流的首选方法。
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Treatment of hydrocephalus following fetal repair of myelomeningocele: comparing endoscopic third ventriculostomy with choroid plexus cauterization to ventricular shunting.

Objective: The aim of this study was to compare clinical and craniometric outcomes of patients treated for hydrocephalus following fetal myelomeningocele repair (fMMR) via a ventriculoperitoneal shunt (VPS) or endoscopic third ventriculostomy with choroid plexus cauterization (ETV/CPC).

Methods: This was a retrospective cohort study of children who were treated for hydrocephalus following fMMR via VPS or ETV with or without CPC (ETV ± CPC) at Vanderbilt between 2012 and 2021. The primary outcomes were treatment failure and time to failure (TTF). Secondary outcomes included changes in hydrocephalus metrics (fronto-occipital horn ratio [FOHR] and head circumference measurements) and healthcare resource utilization (number of hospital admissions, clinic visits, and neuroimaging findings).

Results: Among 88 patients who underwent fMMR, 37 (42%) required permanent CSF diversion, of whom 19 received treatment at the authors' institution. Twelve patients underwent ETV ± CPC, and 7 underwent VPS placement at a median corrected age of 23 weeks versus 1 week (p = 0.002). The preoperative median head circumference percentiles and z-scores for patients in the ETV ± CPC cohort were similar to those of the VPS cohort (percentiles: 98.5 vs 94.0, p = 0.064; z-scores: 2.32 vs 1.60, p = 0.111). There was no difference in preoperative median FOHR measurements between the two cohorts (0.57 vs 0.59, p = 0.53). At 6 months postoperatively, the median head circumference percentile and z-score for the ETV ± CPC cohort remained similar between the two cohorts (percentiles: 98.0 vs 67.5, p = 0.315; z-scores: 2.12 vs 0.52, p = 0.307). There was no difference in the change in FOHR (-0.06 vs -0.09, p = 0.37) and change in head circumference percentile (-1.33 vs -28.6, p = 0.058) between the cohorts 6 months after the index CSF diversion procedure. One patient in the ETV ± CPC cohort experienced a seizure and a nonoperative subdural hemorrhage postoperatively; no other complications were observed. Six of the 7 patients in the VPS cohort required shunt revision with a median TTF of 9.8 months while 2 of the 12 ETV ± CPC patients required a repeat ETV at a median of 17.5 months (86% vs 17%, p = 0.013). The median number of hydrocephalus-related hospital readmissions was significantly lower in the ETV ± CPC cohort than in the VPS cohort (0 vs 1, p = 0.006). The ETV ± CPC cohort had fewer CT scans (0 vs 2, p = 0.004) and radiographs (0 vs 2, p < 0.001) than the VPS cohort.

Conclusions: In a single-center cohort, hydrocephalic fMMR patients treated via ETV ± CPC remained shunt free, while a majority of patients receiving an upfront shunt required revision. This is the first study comparing ETV ± CPC with VPS in the fMMR hydrocephalus population. While larger, multicenter studies are needed, these results suggest that ETV/CPC may be a preferred means of CSF diversion following fMMR.

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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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