PEDİATRİK YAŞ GRUBUNDA ENDOSKOPİK ÜÇÜNCÜ VENTRİKÜLOSTOMİ YAPILAN HASTALARIN RETROSPEKTİF ANALİZİ

Öz

Amaç: Hidrosefali ameliyatlarında ventrikülo-peritoneal (V/P) şant ve endoskopik üçüncü ventrikülostomi (EÜV) sıklıkla tercih edilen cerrahilerdir. Çalışmamızda 17 yaş altında EÜV yapılan hastaların yaş ve cinsiyete göre dağılımlarını, cerrahi komplikasyonlarını ve V/P şant ihtiyaçlarının incelenmesi amaçlanmıştır. Gereç ve Yöntem: Ocak 2015-Haziran 2022 tarihleri arasında İstanbul Üniversitesi İstanbul Tıp Fakültesi, Beyin ve Sinir Cerrahisi Anabilim Dalı’nda 17 yaş altında EÜV ameliyatı yapılan 44 hasta çalışmaya dahil edilmiştir. Hastaların klinik ve radyolojik sonuçları retrospektif olarak değerlendirilmiştir. Bulgular: Endoskopik üçüncü ventrikülostomi yapılan hastaların 24’ü kadın (%54,5), 20’si erkekti (%45,4). Hastaların ortalama yaşları 7,3 idi. En sık hastaneye başvuru şikâyetleri 11 hastada saptanan (%25) baş ağrısı ve 10 hastada saptanan(%22,7) baş çevresinde artıştı. İncelenen hastalar arasında hidrosefalinin en yaygın nedeni intrakraniyal tümördü (%34). Daha önce V/P şant operasyonu yapılan ve takiplerinde şant disfonksiyonu gelişen beş (%11,3) hastaya EÜV yapıldı. EÜV yapılmış 44 hastanın 30’unda (%68,1) hidrosefalinin gerilediği görülürken, 14 hasta (%31,8) ikinci kez opere edilerek V/P şant takıldı. EÜV sonrası ikinci kez opere edilerek V/P şant takılan 14 hastanın 7’sine (%50) ilk ayda, 4’üne (%28,5) ise EÜV sonrası 1-3 aylık süreçte V/P şant takıldı. EÜV yapılan hastaların beşinde (%11,3) postoperatif yara yeri problemi geliştiği görüldü. Sonuç: Geleneksel şant cerrahisine kıyasla EÜV komplikasyon riskinin daha düşük olması ve operasyon sonrası yaşam kalitesini arttırması gibi birçok avantaj sunar. Çocuklarda ETV'nin başarısı çeşitli faktörlerden etkilenebilmesine rağmen prosedürün birçok pediatrik hastada güvenli ve etkili olduğu gösterilmiştir.

Anahtar Kelimeler

• Hidrosefali
• endoskopik üçüncü ventrikülostomi
• ventriküloperitoneal şant

RETROSPECTIVE ANALYSIS OF PEDIATRIC HYDROCEPHALUS PATIENTS TREATED WITH ENDOSCOPIC THIRD VENTRICULOSTOMY

Öz

Objective: Ventriculoperitoneal (VP) shunt and endoscopic third ventriculostomy (ETV) are commonly utilized surgical interventions for managing hydrocephalus. This study aimed to analyze ETV procedures performed on patients under 17 years of age, focusing on demographic factors such as age and gender, etiological considerations, surgical complications, and the necessity for VP shunt placement. Material and Method: A retrospective review was conducted on pediatric patients who underwent ETV for hydrocephalus at the Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, spanning from January 2015 to June 2022. The study encompassed 44 patients aged 17 years or younger, with assessments made retrospectively based on clinical and radiological outcomes. Result: Among the 44 patients subjected to ETV for hydrocephalus, 24 were female (54.5%) and 20 were male (45.4%), with a mean age of 7.3 years. The most prevalent presenting symptom was headache, reported by 11 patients (25%), followed by increased head circumference in 10 patients (22.7%). The primary etiology of hydrocephalus was intracranial tumors (34%). In five patients (11.3%), ETV was performed to address shunt malfunction following a prior VP shunt procedure. Regression of hydrocephalus occurred in 30 patients (68.1%), while 14 patients (31.8%) necessitated a subsequent VP shunt placement. Postoperative wound complications were documented in five patients (11.3%). Conclusion: ETV offers distinct advantages over traditional shunt surgery, including reduced complication risks and enhanced quality of life. Despite the influence of various factors on the success of ETV in pediatric cases, the procedure has demonstrated safety and efficacy in a significant number of patients in this demographic.

Anahtar Kelimeler

• Hydrocephalus
• endoscopic third ventriculostomy
• ventriculoperitoneal shunt

Kaynakça

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