神经内镜脑室应用解剖学研究与临床应用

Study of Anatomy of Cerebral Ventricles via Endoscope and its Clinical Value

目的研究脑室的神经内镜解剖学特点,探讨其临床应用价值。方法在15例尸颅标本及20例脑积水患者术中用神经内镜观察侧脑室、第三脑室的解剖结构。采用神经内镜治疗脑积水20例,其中行ETV16例,1例行透明隔造瘘术,3例行脑室-腹腔分流术,并分析其临床和影像学结果。结果脉络丛、室间孔、乳头体及导水管开口等是内镜经额角入路观察侧脑室和第三脑室的重要“路标”。20例脑积水患者治疗后,19例症状好转,影像学复查脑室缩小的14例;1例脑转移瘤引起的脑积水患者,术后3月死亡。并发脑膜炎1例,发热2例,1例切口愈合不良,4例ETV术后并发头皮下少量积聚液,出血2例。结论经额角入路观察范围最大,是脑室内神经内镜手术的最常用入路。对于多种原因引起的梗阻性脑积水患者ETV有很好的效果。慎重选择造瘘部位和器械对于避免出血等严重并发症有重要意义。

Objective To study the endoscopic anatomy of supratentorial ventricles and its clinical value. Methods The anatomic characters of both the lateral ventricles and third rentricle was observed through an endoscope in 15 cadavers and 20 patients with hydricephalus, who received neuroendoscope surgery. Of the 20 patients, 16 were treated by endoscopic third ventriculostomy （ETV）, 1 by pellucid septostomy and 3 by ventriculoperitoneal shunt. Their clinical and radiological data were analyzed. Results The important ＂road mark＂ in the lateral and third ventricles included the choroids plexus, Monro foramen, mamillary body, the open of aqueduct and so on. Of 20 patients with hydrocephalus, 19 were improved in the clinical symptom and 1 died of brain metastasis. The cerebral ventricle shrank on the imaging in 14 patients. The complications included meningitis （2 cases）, fever （2）, second intention of the cut （1）, intracranial hemorrhage （2） and subscalp fluid collection （4）. Conclusions The visual field under the endoscope is the largest when the ventricles were observed via the front horn approach. The front horn approach is the best one of the endoscope surgery for lesions in the ventricles. ETV is an effective method of treating obstructive hydrocephalus caused by aqueduct stenosis and occupying lesions in posterior cranial fossa and midbrain. It is vary important to select right puncture site and use right insertion of the instrument for preventing postoperative hemorrhage and complications.