应用腔内超声检查的内镜三脑室底造瘘术

Application of ultrasonic microvascular doppler probe in endoscopic third ventriculostomy

目的探讨在治疗脑积水的内镜三脑室底造瘘术(endoscopic third ventriculostomy ETV)中,应用多普勒微血管探头作超声扫描检查的意义。方法单纯神经内镜下完成梗阻性脑积水ETV 34例,其中21例应用多普勒微血管探头经内镜通道抵达三脑室底部进行超声探测,监测基底动脉的走向、血流速度,进行术中实时定位,造瘘前后记录血管的多普勒超声图像。结果21例造瘘术前后BA的管径、血流速度无变化,无血管损伤并发症。术后21例(61.76%)影像学证实扩大的脑室术后有回缩;半年后症状缓解29例(85.29%),5例无效(14.71%),2例做脑室腹腔分流术。无手术死亡或残疾。结论多普勒微血管探头在ETV中加以应用,可减少血管损伤类并发症的发生,使得内镜插入定位精确,安全。

Objective: To evaluate the usefulness of intraoperative microvascular Doppler sonography in endoscopic third ventriculostomy (endoscopic third ventriculostomy ETV). Methods: Simplex neuroendoscopic third ventriculostomys were completed for 34 obstructive hydrocephalus patients. In 21 cases, Doppler microvasculer probes were inserted in the bottom of third ventricle through endoscopic work channels, finish ultrasonic sonography, such as inspecting speed and direction of blood stream of basal artery, perform real-time view and register ultrasonic scan image before and after fenestration. Results: In 21 cases, diameter and velocity of BA have not distinction before and after fenestration and vascular injury complications. The ventricles of 21 in 34 (61.76%) patients were contracted, approved by image inspecting in half year operations. 29 patients (85.29%) were symptom-free or improved, 5 patients (14.71) had no change, 2 patients had to taken in V-P shunt. Mortality as well as morbidity were zero. Conclusions: Doppler microvasculer probe can be used in ETV to inspect the important vascular through the endoscopic cancal, the complications of arteries injury could be avoided effectively. The scan during operation can increase security and accuracy of puncturing bottom of third ventricle.