Abstract：
The use of endoscopic third ventriculostomy (ETV) for treatment of pediatric hydrocephalus has higher failure rates in younger patients. Here we investigate the impact of select perioperative variables, specifically gestational age, chronological age, birth weight, and surgical weight, on ETV failure rates. A retrospective review was performed on patients treated with ETV - with or without choroid plexus cauterization (CPC) - from 2010 to 2021 at a large academic center. Analyses included Cox regression for independent predictors and Kaplan-Meier survival curves for time to-event outcomes. In total, 47 patients were treated with ETV; of these, 31 received adjunctive CPC. Overall, 66% of the cohort experienced ETV failure with a median failure of 36 days postoperatively. Patients aged < 6 months at time of surgery experienced 80% failure rate, and those > 6 months at time of surgery experienced a 41% failure rate. Univariate Cox regression analysis showed weight at the time of ETV surgery was significantly inversely associated with ETV failure with a hazard ratio of 0.92 (95% CI 0.82, 0.99). Multivariate analysis redemonstrated the inverse association of weight at time of surgery with ETV failure with hazard ratio of 0.76 (95% CI 0.60, 0.92), and sensitivity analysis showed < 4.9 kg as the optimal cutoff predicting ETV/CPC failure. Neither chronologic age nor gestational age were found to be significantly associated with ETV failure.In this study, younger patients experienced higher ETV failure rates, but multivariate regression found that weight was a more robust predictor of ETV failure than chronologic age or gestational age, with an optimal cutoff of 4.9 kg in our small cohort. Given the limited sample size, further study is needed to elucidate the independent role of weight as a peri-operative variable in determining ETV candidacy in young infants. Previous presentations: Poster Presentation, Congress of Neurological Surgeons.
摘要：
在年轻患者中，使用内镜下第三脑室造瘘术（ETV）治疗小儿脑积水的失败率较高。在这里，我们调查选择围手术期变量的影响，特别是胎龄，实际年龄,出生体重,和手术重量，ETV故障率。从2010年到2021年，在大型学术中心对接受ETV治疗的患者进行了回顾性审查-有或没有脉络丛烧灼术（CPC）。分析包括独立预测因子的Cox回归和事件发生时间的Kaplan-Meier生存曲线。总的来说,47例患者接受ETV治疗；其中，31人获得了辅助方案协调会。总的来说,66％的队列经历了ETV失败，中位失败为术后36天。年龄<6个月的患者在手术时经历了80%的失败率,而手术时间>6个月的患者的失败率为41%。单变量Cox回归分析显示，ETV手术时的体重与ETV失败显着负相关，风险比为0.92（95％CI0.82，0.99）。多变量分析再次证明了手术时体重与ETV失败的负相关，风险比为0.76（95％CI0.60，0.92），敏感性分析表明，<4.9kg是预测ETV/CPC失败的最佳临界值。没有发现年龄和胎龄与ETV失败显着相关。在这项研究中,年轻患者经历较高的ETV失败率，但多元回归发现，体重是一个更强大的预测ETV失败比实际年龄或胎龄，在我们的小队列中，最佳临界值为4.9公斤。鉴于样本量有限，需要进一步研究来阐明体重作为围手术期变量在确定年轻婴儿ETV候选人资格方面的独立作用.以前的演示文稿：海报演示,神经外科医师大会。
