再次内镜下第三脑室造瘘与脑室腹腔分流在小儿脑积水患者内镜下第三脑室造瘘失败:一项系统回顾。

Surgical neurology international Pub Date : 2025-05-30 eCollection Date: 2025-01-01 DOI:10.25259/SNI_1111_2024
Ikhlas Ahmed, Usama Choudry, Karim Rizwan Nathani, Abdul Basit, Saad Akhtar Khan, Roua Nasir, Minza Haque, Ahmed Noor, Muhammad Saad Pasha, Aabiya Arif, Naveed Zaman Akhunzada, Oswin Godfrey
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引用次数: 0

摘要

背景:本研究的目的是比较小儿脑积水患者内镜下第三脑室造口术(ETVs)失败的内镜治疗与分流手术。方法:我们对诊断为脑积水的儿科患者(0-18岁)的研究进行了系统评价和荟萃分析指南的首选报告项目进行了系统评价,报告了重复ETV (Re-ETV)或脑室-腹膜分流术(VPS)作为ETV失败后的治疗选择。比较研究包括随机对照试验、队列研究和任何前瞻性研究。包括2001年至2023年间用英语发表的研究。结果:选取40篇文章进行全文综述。其中9篇文章明确讨论了主ETV故障后的Re-ETV和/或VPS放置的主题,被认为适合进行分析。分析了663例患者的数据集。220例(33.18%)患者行Re-ETV, 443例(66.81%)患者行VPS置入术。原发性ETV失败率为16.6% ~ 60.89%。Re-ETV的失败率(74.98%)高于VPS(22.26%),表明VPS作为次要干预通常更成功。初次ETV时出血的存在表明VPS置放比二次ETV更有益处(P < 0.05)。结论:我们的系统回顾表明,在原发性ETV失败后,VPS放置是更普遍的选择,可能是由于其更高的总体成功率和并发症的性质。失败率和随访时间的广泛差异表明,患者和研究之间的治疗结果可能存在很大差异。关于二次干预的决定应个体化,考虑患者的具体因素,如年龄、并发症和干预时间。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Re-endoscopic third ventriculostomy versus ventriculoperitoneal shunting in failed endoscopic third ventriculostomy in pediatric patients with hydrocephalus: A systematic review.

Background: The objective of this research article is to compare endoscopic treatment versus shunting procedures for failed endoscopic third ventriculostomies (ETVs) in pediatric patients with hydrocephalus.

Methods: We did a systematic review based on preferred reporting items for systematic reviews and meta-analyses guidelines on Studies involving pediatric patients (aged 0-18 years) diagnosed with hydrocephalus, reporting on the use of repeat ETV (Re-ETV) or Ventriculoperitoneal shunting (VPS) as a treatment option following failed ETV. Comparative studies, including randomized controlled trials, cohort studies, and any prospective studies, are included. Studies published in the English language conducted between 2001 and 2023 are included.

Results: Forty articles were selected for full-text review. Out of which nine articles that clearly addressed the topic of Re-ETV and/or VPS placement after failure of primary ETV were deemed suitable for analysis. A data set of 663 patients was analyzed. Re-ETV was done in 220 patients (33.18%) and VPS Placement was done in 443 patients (66.81%). The primary ETV failure rates ranged from 16.6 to 60.89%. There was a higher failure rate of Re-ETV (74.98%) compared to VPS (22.26%) indicating that VPS is generally more successful as a secondary intervention. The presence of hemorrhage during primary ETV suggested more benefit from VPS placement rather than Re-ETV (P < 0.05).

Conclusion: Our systematic review suggests that VPS placement is the more prevalent choice after primary ETV failure, likely due to its higher overall success rate and the nature of complications. The wide variability in failure rates and follow-up durations suggests that treatment outcomes can differ greatly between patients and studies. Decisions regarding secondary interventions should be individualized, considering patient-specific factors such as age, complications, and timing of intervention.

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