BACKGROUND Preoperative judgment who will benefit from endoscopic third ventriculostomy (ETV) in infantile hydrocephalus remains controversial and no sufficient clue exists. Although ETV success score (ETVSS) is a useful scale in predicting ETV success in hydrocephalus, its efficacy in infants younger than 1 year old has been limited. This study aimed to verify the efficacy of a newly defined sign, "third ventricle floor bowing (TVFB)," in predicting ETV success in infantile hydrocephalus for the first time and discuss the mechanism of this sign and its clinical meanings. METHODS Between January 2013 and April 2018, hydrocephalic infants (age ≤ 12 months) with third ventricle floor bowing were treated endoscopically in the Department of Neurosurgery, West China Hospital. The medical records of these patients were reviewed. Additionally, we undertook a detailed review of the reported data on the treatment of infantile hydrocephalus with endoscopic third ventriculostomy (ETV). RESULTS A total of 42 infants underwent ETV alone in our institution, with a median age of 7.3 ± 3.8 months. Common etiologies included postinfectious (26.2%), arachnoid cyst (14.3%), aqueductal stenosis (11.9%), and congenital condition (11.9%). The complications included seizure (2.4%), CSF leak (2.4%), and subdural effusion (2.4%). During the average follow-up of 21.7 ± 13.1 months, the ETV success rate predicted by third ventricle floor bowing (TVFB) was 71.4%, which was higher than 6-month success rate predicted by the ETVSS (52.3%). However, it was difficult to reach statistical significance (P = 0.072) due to the limited sample size and further studies with larger sample size were needed. CONCLUSIONS Our study suggests TVFB can serve as a useful method for selecting ETV candidates in infantile hydrocephalus preoperatively. And we speculate that good ventricle compliance and pressure difference between the ventricle and subarachnoid space are essential elements in ensuring ETV success.

中文翻译：

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第三脑室底部弯曲：一种有用的测量方法，可预测内镜下婴儿脑积水第三脑室造口术的成功率。

背景技术术前判断谁将受益于婴儿脑积水的内窥镜第三脑室造口术（ETV）仍存在争议，并且没有足够的线索。尽管ETV成功评分（ETVSS）是预测脑积水ETV成功的有用量表，但其在1岁以下婴儿中的疗效有限。这项研究旨在验证新定义的征兆“第三脑室底弓（TVFB）”在首次预测婴儿脑积水ETV成功方面的功效，并讨论该征兆的机制及其临床意义。方法2013年1月至2018年4月，在华西医院神经外科内镜下对第三脑室下弯的脑积水婴儿（≤12个月）进行了内镜治疗。这些患者的病历进行了审查。另外，我们对内镜下第三脑室造口术（ETV）治疗婴儿脑积水的报道数据进行了详细回顾。结果在我们的机构中​​，共有42例婴儿单独接受了ETV，中位年龄为7.3±3.8个月。常见病因包括感染后（26.2％），蛛网膜囊肿（14.3％），导尿管狭窄（11.9％）和先天性疾病（11.9％）。并发症包括癫痫发作（2.4％），脑脊液漏（2.4％）和硬膜下积液（2.4％）。在平均随访21.7±13.1个月中，第三脑室底弓（TVFB）预测的ETV成功率为71.4％，高于ETVSS预测的6个月成功率（52.3％）。然而，由于样本量有限，难以达到统计学显着性（P = 0.072），并且需要对更大样本量进行进一步研究。结论我们的研究表明TVFB可作为术前选择婴儿脑积水中ETV候选者的有用方法。并且我们推测，良好的心室顺应性以及心室与蛛网膜下腔之间的压力差是确保ETV成功的关键要素。