The application effect of neuroendoscopic third ventriculostomy in children with ventriculoperitoneal shunt dysfunction
Objective To investigate the effect of endoscopic third ventriculostomy(ETV)on the treatment of ventriculoperitoneal(VP)shunt malfunction in children.Methods The clinical data of 29 children with VP shunt dysfunction after hydrocephalus surgery who were admitted to the Neurosurgery Department of the Pediatric Hospital of Fudan University from June 2016 to June 2023 were retrospectively analyzed.All children underwent ETV.Based on the improvement of clinical symptoms after surgery,the criterion for success of ETV was that ventriculo-peritoneal shunt(VPS)was not performed again for 3 months or more after operation,while the criterion for failure of ETV was that VPS was performed again within 3 months after ETV.Results Among the 29 child patients,18 were male and 11 were female;the age of ETV child patients[M(Q1,Q3)]was 84.0(46.5,120.5)months,and the age of first VPS treatment[M(Q1,Q3)]was 5.7(2.0,18.0)months.Twenty patients were diagnosed with obstructive hydrocephalus and 9 patients with communicating hydrocephalus.The causes of shunt dysfunction were shunt-related infection in 3 cases,shunt displacement and head-end obstruction in 19 cases,shunt rupture in 3 cases,and slit ventricular syndrome(SVS)in 4 cases.The longest follow-up time of 29 child patients was 90 months.As of the last follow-up,the effective rate of ETV was 55.2％(16/29),among which the effective rate of ETV in patients with communicating hydrocephalus was 6/9,and the effective rate of ETV in child patients with obstructive hydrocephalus was 50.0％(10/20).The ETV effective rate of patients with communicating hydrocephalus tended to be higher than that of child patients with obstructive hydrocephalus,but the difference was not statistically significant(P＞0.05).The success rate of surgery in 4 patients with SVS was only 1/4.Conclusion ETV has a certain application effect in VP shunt dysfunction.It can be used as an alternative to shunt revision surgery and can be applied in patients with any type of VP shunt dysfunction.
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