背景:内镜下第三脑室造口术(ETV)越来越多地被接受为替代脑积水的脑室-腹膜(VP)分流术的治疗选择。然而,他们在认知和生活质量(QOL)评分方面的差异在儿童中没有得到太多研究。
目的:为了比较结果,认知功能,ETV和VP分流之间的QOL。
方法:接受ETV或/和VP分流治疗的非肿瘤性脑积水患者接受认知评估(使用按年龄组标准化的改良儿童MMSE)和QOL(使用按年龄组的PedsQL,情感,社会,和学校功能领域),以及不需要额外干预的结果。
结果:在139名患者中,有29名婴儿和40名14岁以下的儿童。在这些孩子中,ETV是45例的主要干预措施,VP分流24例,可以进行平均1.7年的随访研究。尽管ETV需要比VP分流更少的额外干预(19.2%vs.28.6%)在幼儿和年龄较大的儿童中,总体上没有显着差异。低于正常的认知得分占25%,40%,在ETV之后的50%,单分流手术,和多次分流手术,分别,差异无统计学意义。在QOL的不同领域中,ETV后,儿童报告的社会领域得分明显优于VP分流术(475[+13]vs.387[+43],P值0.03),而大多数其他分数在ETV之后没有显着改善。
结论:接受ETV的患者显示出更好的临床结果的趋势,认知功能,和QOL,儿童报告的社会领域QOL得分明显更好。
BACKGROUND: Endoscopic Third Ventriculostomy (ETV) is increasingly being accepted as the treatment of choice in place of Ventriculo-Peritoneal (VP) Shunt for hydrocephalus. However, their differences in cognitive and Quality of Life (QOL) scores have not been studied much in children.
OBJECTIVE: To compare the outcome, cognitive function, and QOL between ETV and VP shunt.
METHODS: Patients of non-tumor hydrocephalus treated with ETV or/and VP shunt underwent cognitive assessment (using modified child MMSE standardized as per the age group) and QOL (using PedsQL as per the age group in Physical, Emotional, Social, and School Functioning domains) in addition to the outcome of not requiring additional intervention.
RESULTS: Out of 139 patients, there were 29 infants and 40 children upto 14 years. Among these children, ETV was the primary intervention in 45, VP shunt in 24, and could be studied for a mean follow-up of 1.7 years. Though ETV required lesser additional intervention than VP shunt (19.2% vs. 28.6%) in toddlers and older children, there was no overall significant difference. Subnormal cognitive scores were noted in 25%, 40%, and 50% after ETV, single shunt procedure, and multiple shunt procedures, respectively, with no statistically significant difference. Among the different domains of QOL, the child reported scores in the social domain were significantly better after ETV than VP shunt (475[+13] vs. 387[+43], P value 0.03), whereas most other scores were non-significantly better following ETV.
CONCLUSIONS: Patients who underwent ETV show a trend for better clinical outcome, cognitive function, and QOL with significantly better child-reported QOL scores in the social domain.