Long-term quality of life after ETV or ETV with consecutive VP shunt placement in hydrocephalic pediatric patients.

IF 1.2
Victoria Bogaczyk, Steffen Fleck, Julia Berneiser, Michael Opolka, Marcus Vollmer, Jörg Baldauf, Christin Maria Gasch, Eva Maria Lemke, Ehab El Refaee, Marc Matthes, Holger Hirschfeld, Heinz Lauffer, Michael Gaab, Henry Schroeder, Sascha Marx
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Abstract

Purpose: Endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunting are well-established treatments of obstructive hydrocephalus (HCP) in adult and pediatric patients. However, there is a lack of data with regard to the quality of life (QoL) of these patients during long-term follow-up METHODS: Inclusion criteria were pediatric patients with endoscopic treatment of hydrocephalus at the University Medicine Greifswald between 1993 and 2016. Patients older than 14 years at present were assessed with the Short Form-12 (SF-12) questionnaire. Patients younger than 14 years of age were assessed with the KINDL-R questionnaire that was completed by their parents. Patients' values were compared with the scores of a corresponding age-matched group of the healthy population and with patients who received later shunt treatment. Information about comorbidities, current symptoms, and educational level were gained by an additional part. Comparative analysis between patients with ETV success and failure (defined as shunt implantation after ETV) was performed.

Results: A total of 107 patients (53 m, 54f) were included. Fifty-seven/107 patients (53.3%) were considered as ETV success. Mean age at ETV was 6.9 ± 5.9 years. Fifty-four statements of 89 patients that are still alive were gained (response rate 63%). Of these, 49 questionnaires were complete and evaluable (23 m, 26f; mean age 19.8 ± 10.0 years with an average follow-up period of 13.7 ± 7.2 years). Twenty-six/49 patients (53.1%) are considered ETV success. No statistically significant differences could be obtained between patients with ETV success and ETV failure. Patients older 14 years show QoL within normal range, patients younger than 14 years show significantly lower result regarding their environment of peers and social contacts. Patients younger than 6 months at the time of ETV and patients with posthemorrhagic HCP show significantly lower physical QoL. Gait disturbance, fatigue, and seizures are associated with a lower QoL, and educational level is lower than in the normal population.

Conclusions: Patients who underwent ETV in childhood do not have a lower health-related QoL in general. Subsequent insertions of ventriculoperitoneal (vp) shunts do not lower QoL. Certain subgroups of the patients show lower results compared to the healthy population.

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脑积水儿童患者ETV或ETV合并连续VP分流器放置后的长期生活质量。
目的:内镜下第三脑室造口术(ETV)和脑室腹腔分流术是治疗成人和儿童阻塞性脑积水(HCP)的有效方法。然而,在长期随访期间缺乏关于这些患者生活质量(QoL)的数据。方法:纳入标准是1993年至2016年在Greifswald大学医学院(University Medicine Greifswald)接受内窥镜治疗的儿科脑积水患者。目前年龄大于14岁的患者采用简短表格-12 (SF-12)问卷进行评估。14岁以下的患者由父母填写KINDL-R问卷进行评估。将患者的评分与相应年龄匹配的健康人群和接受分流治疗的患者的评分进行比较。关于合并症、当前症状和教育水平的信息通过附加部分获得。对ETV成功与失败患者(定义为ETV术后分流器植入)进行对比分析。结果:共纳入107例患者(53例,54例)。57 /107例患者(53.3%)认为ETV成功。平均年龄为6.9±5.9岁。89例仍然存活的患者获得54例陈述(有效率63%)。其中,49份问卷是完整的和可评估的(23 m, 26f;平均年龄19.8±10.0岁,平均随访时间13.7±7.2年。49例患者中有26例(53.1%)认为ETV成功。ETV成功患者与ETV失败患者之间无统计学差异。年龄在14岁以上的患者生活质量在正常范围内,年龄在14岁以下的患者在同伴环境和社会交往方面的生活质量明显低于14岁。ETV时年龄小于6个月的患者和出血性HCP患者的物理生活质量明显降低。步态障碍、疲劳和癫痫发作与较低的生活质量有关,教育水平低于正常人群。结论:儿童期接受ETV治疗的患者总体上没有较低的健康相关生活质量。随后的脑室-腹膜(vp)分流术并不会降低生活质量。与健康人群相比,某些亚组患者的结果较低。
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