World neurosurgery · 2019
Efficacy and Safety of Lumboperitoneal Shunt in the Treatment of All-Cause Communicating Hydrocephalus: Analysis of Risk Factors of Shunt Failure.
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Sun Tong, Li Xuepei, Zhang Qiuming, Zhou Yicheng, Guan Junwen
Аннотация
OBJECTIVE: To analyze the outcomes of use of a lumboperitoneal shunt (LPS) to treat all-cause communicating hydrocephalus (ACCH).
METHODS: We analyzed the outcomes of adult patients with ACCH treated with an LPS between June 2015 and June 2018, using Keifer's hydrocephalus score (KHS), postoperative symptom improvement score (SIS), and the Evans index for 5 days after surgery. All patients were followed up to assess long-term outcomes and quality of life. Based on the follow-up data in shunt successful (SS) patients and shunt failure (SF) patients, multivariate analysis with binary logistic regression was used to identify risk factors for LPS failure.
RESULTS: A total of 71 eligible patients were included in this study. The KHS (mean, 8.31 ± 4.80 vs. 3.65 ± 3.08; P < 0.001) and Evans index (mean, 0.35 ± 0.05 vs. 0.28 ± 0.05; P < 0.001) were significantly improved following LPS. However, the overall incidence of complications was 40.8%. According to follow-up data, 18 patients (25.4%) failed; the most common reason for failure was catheter obstruction. The majority of patients obtain good prognosis with low level of RBCs counts in CSF (P = 0.039) and postoperative Evans index (P = 0.046) were statistically different between SS and SF group. The multivariate analysis identified elevated RBC count in CSF as a dependent risk factor for LPS failure (odds ratio, 24.111; 95% confidence interval, 2.611-222.629; P = 0.005).
CONCLUSIONS: Our findings indicate that LPS may be a promising option for the treatment of ACCH.
METHODS: We analyzed the outcomes of adult patients with ACCH treated with an LPS between June 2015 and June 2018, using Keifer's hydrocephalus score (KHS), postoperative symptom improvement score (SIS), and the Evans index for 5 days after surgery. All patients were followed up to assess long-term outcomes and quality of life. Based on the follow-up data in shunt successful (SS) patients and shunt failure (SF) patients, multivariate analysis with binary logistic regression was used to identify risk factors for LPS failure.
RESULTS: A total of 71 eligible patients were included in this study. The KHS (mean, 8.31 ± 4.80 vs. 3.65 ± 3.08; P < 0.001) and Evans index (mean, 0.35 ± 0.05 vs. 0.28 ± 0.05; P < 0.001) were significantly improved following LPS. However, the overall incidence of complications was 40.8%. According to follow-up data, 18 patients (25.4%) failed; the most common reason for failure was catheter obstruction. The majority of patients obtain good prognosis with low level of RBCs counts in CSF (P = 0.039) and postoperative Evans index (P = 0.046) were statistically different between SS and SF group. The multivariate analysis identified elevated RBC count in CSF as a dependent risk factor for LPS failure (odds ratio, 24.111; 95% confidence interval, 2.611-222.629; P = 0.005).
CONCLUSIONS: Our findings indicate that LPS may be a promising option for the treatment of ACCH.