脑室镜治疗33例梗阻性脑积水

Ventricular Endoscopy for Obstructive Hydrocephalus: Report of 33 Cases

目的 探讨脑室镜在梗阻性脑积水中的治疗方法和技巧. 方法 2003年6月～2006年12月,采用脑室镜治疗梗阻性脑积水33例,术前均行头部CT、MRI、同位素99mTc-DTPA脑池显像检查,行脑室镜下第三脑室造瘘术. 结果 32例造瘘成功,1例瘘口下出血放弃治疗死亡.13例手术后发热,1例手术后6个月双侧慢性硬膜下血肿(经钻孔引流后痊愈),3例术后6个月手术侧硬脑膜下积液(因无特殊不适予以随访观察).随访2～42个月,平均16.7月,32例手术后临床症状均缓解.32例造瘘手术前腰穿测压平均26(16～39) cm H2O,手术后7天为22(11～28) cm H2O,术后7天颅内压显著下降(t=2.903,0.005＜P＜0.01).术后7天复查CT、MRI,25例侧脑室体部横径较术前缩小,平均缩小2.3(0.7～4.6)mm,7例侧脑室大小无变化;32例侧脑室旁水肿均消失.1例术前合并小脑扁桃体下疝者手术后7天复查MRI见下疝的小脑扁桃体向上移位4 mm. 结论 脑室镜手术是治疗梗阻性脑积水的安全有效的方法.

Objective To discuss the techniques of ventricular endoscopy for obstructive hydrocephalus.Methods A total of 33 patients with obstructive hydrocephalus were treated by ventriculostomy using ventricular endoscopy from June 2003 to December 2006.The patients had received CT,MRI,and 99mTc-DTPA cistern SPECT before the surgery.Results Endoscopic third ventriculostomy was performed successfully in 32 patients,the other patient died of hemorrhage under the third ventricle fistula.Postoperative fever occurred in 13 patients.One patient developed bilateral chronic subdural hematoma 6 months after the operation,and was cured by drill and drainage.Three patients developed subdural hydroma 6 months postoperation without showing symptoms.They were monitored without any treatment.The 32 patients were followed up for 2-42 months(mean,16.7 months),all of them achieved clinical relieve.In the patients,the intracranial pressure(ICP) was 26(16-39) cm H2O before the operation,and was significantly decreased to 22(12-28) cm H2O 7 days after the operation(t=2.903,0.005<P<0.01).Seven days after the operation,CT and MRI showed that the lateral ventricle width was reduced by a mean of 2.3 mm(0.7-4.6) in 25 cases.The other 7 patients had no change in the width of the third ventricle.The paraventricular edema disappeared in all the patients.In one patient,who had cerebellar tonsillar herniation before the operation,the MRI performed 7 days postoperation showed that the cerebellar tonsil moved upward by 4 mm.Conclusions The endoscopic third ventriculostomy is safe and effective for obstructive hydrocephalus.