Endoscopic third ventriculostomy in idiopathic normal pressure hydrocephalus. Efficacy and possible positive predictors: a systematic review

IF 2.5 Q3 CLINICAL NEUROLOGY
Karel Pištěk , Martin Sameš , Tomáš Radovnický
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Abstract

Introduction

Current best practice for the treatment of idiopathic normal pressure hydrocephalus (iNPH) involves ventriculoperitoneal shunt implantation, which is associated with several long-term complications. Throughout the last two decades endoscopic third ventriculostomy (ETV) has emerged as an alternate therapeutic modality. This modality promises a lower incidence of surgical and postoperative complications. This review focuses on patients with iNPH treated via ETV, compares the efficacy of ETV between individual studies and summarizes predictive measures of ETV success.

Methods

The development of the protocol was guided by the Preferred Reporting Items for Systematic Review and MetaAnalysis Protocols 2015 statement. Relevant literature was selected using complex registers and in several bibliographical databases. A total of 17 original articles comparing the efficacy of ETV were selected for the review, 12 of which were used to analyze positive predictors of ETV therapy.

Results

A total of 282 patients with iNPH underwent ETV, with an average efficacy 63.7 %. Positive predictors of ETV treatment were the presence of pathological outflow resistance (Rout) in the ventricular compartment during cerebrospinal fluid (CSF) dynamic tests, hyperdynamic CSF flow, functional stenosis of the Sylvian aqueduct and/or bowing of the third ventricle on magnetic resonance imaging (MRI). Further positive predictors included short duration of symptoms and a predominantly gait-centric clinical presentation.

Conclusion

Endoscopic treatment of patients with iNPH remains controversial and shunt surgery remains the treatment of choice. The analyzed studies show that a subset of patients profit from ETV. Further studies with robust randomized cohorts comparing ETV to shunting are necessary.
内镜下第三脑室造口术治疗特发性常压脑积水。疗效和可能的积极预测因素:一项系统综述
目前治疗特发性常压脑积水(iNPH)的最佳实践包括脑室-腹膜分流植入,这与几个长期并发症有关。在过去的二十年里,内镜下第三脑室造口术(ETV)已经成为一种替代的治疗方式。这种方式有望降低手术和术后并发症的发生率。本综述的重点是通过ETV治疗的iNPH患者,比较了个别研究之间ETV的疗效,并总结了ETV成功的预测指标。方法根据2015年系统评价和meta分析方案优选报告项目声明制定方案。使用复杂的寄存器和几个书目数据库选择相关文献。我们共选取了17篇比较ETV疗效的原创文章,其中12篇用于分析ETV治疗的积极预测因素。结果282例iNPH患者行ETV治疗,平均有效率63.7%。脑脊液(CSF)动力测试时脑室室存在病理性流出阻力(Rout),脑脊液高动力流动,核磁共振成像(MRI)显示Sylvian导水管功能性狭窄和/或第三脑室弯曲,是ETV治疗的积极预测因素。进一步的阳性预测因素包括症状持续时间短和主要以步态为中心的临床表现。结论内镜下治疗iNPH仍有争议,分流手术仍是首选治疗方法。经分析的研究表明,一部分患者从ETV中获益。有必要对ETV和分流进行更深入的随机队列研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Brain & spine
Brain & spine Surgery
CiteScore
1.10
自引率
0.00%
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0
审稿时长
71 days
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