神经内窥镜第三脑室底造瘘术治疗梗阻性脑积水

Endoscopic third ventriculostomy in the treatment of obstructive hydrocephalus

目的探讨对梗阻性脑积水患者采用神经内窥镜下进行第三脑室底造瘘的手术方法,分析手术成功与失败的原因。方法梗阻性脑积水原因分别为第三脑室后部肿瘤5例,中脑顶板胶质瘤2例,Chiari畸形2例,另12例为不明原因引起的导水管梗阻或狭窄。同位素99Tcm-DTPA脑池显像显示为非脑脊液吸收障碍性阻塞性脑积水。神经内窥镜从侧脑室经蒙氏孔进入第三脑室,在乳头体前方第三脑室底最薄处造一瘘口与脚间池相通。结果术后随访12￣26个月,所有患者脑积水症状均缓解,脑室体积缩小。结论神经内窥镜行第三脑室底造瘘治疗非脑脊液吸收障碍性脑积水是一种有效的微创手术。

Objective To explore the feasibility of endoscopic third ventriculostomy (ETV) for treating obstructive hydrocephalus and analyze the ca uses of the operative success or failure. Methods In 21 patients with obst ructive hydrocephalus (male 12, female 9) aged from 18 months to 41 years (mean, 21.3 years), 5 resulted from posterior third ventricle tumors, 2 from tectal pl ate gliomas, 2 from Chiari malformation, and 12 from obstruction or stenosis of cerebral aqueduct. 99Tcm-DTPA examinations showed obstructed hydrocephalus with normal absorption of cerebral spinal fluid (CSF). The neuroendoscope was inserte d via Monro's foramen into the third ventricle, creating an opening in the floor of third ventricle into interpeduncular cistern. Results All patients had a follow-up ranged from 12 to 26 months and were improved in the clinical signs and ventricle sizes without severe complications. Conclusion ETV is a saf e, effective and minimally invasive method to treat obstructive hydrocephalus wi th normal absorption of CSF.