脑积水内镜下第三脑室底部的形态特征分析

Morphologic feature analysis of the third ventricle floor in patients with hydrocephalus under endoscope

目的研究脑积水第三脑室底部的形态特征,并评估其对内镜下第三脑室底造瘘术(ETV)的影响。方法回顾性分析178例脑积水病人第三脑室底的形态特征,并探讨其对造瘘过程的影响及相关手术技巧。结果第三脑室底形态改变如下:宽度扩张167例,狭窄2例,正常9例;厚度变薄38例,增厚20例,正常120例;角度水平172例,倾斜6例;位置上凸12例,下陷31例,正常135例;解剖标志清晰169例,仅能分辨半透明膜及鞍背,漏斗和乳头体等结构模糊8例,完全无法分辨上述结构1例。ETV过程顺利143例,困难33例,无法完成2例。结论脑积水时第三脑室底解剖形态变异较大,第三脑室底增厚、下陷、倾斜等会增加ETV的操作难度。内镜下完全无法分辨半透明膜、漏斗及乳头体是ETV禁忌证。

Objective To explore the morphologic features of the third ventricle floor in patients with hydrocephalus,and evaluate their influence on the operative procedure of endoscopic third ventriculostomy（ETV）.Methods The morphological features of the third ventri1e floor in 178 patients with hydrocephalus were analyzed retrospectively.Their influence on and related techniques in the operative procedure for ETV were summarized.Results The morphology of the third ventri1e floor changed as follows： the width increased in 167 cases,decreased in 2 and normal in 9.The thickness became thin in 38 cases,thick in 20 and was normal in 120.The angle was horizontal in 172 cases and sloping in 6.The floor raised in 12 cases,sagged in 31 and normal in 135.The anatomical landmarks were clear in 169 cases,only the translucent membrane and dorsum sellae could be distinguished,but indistinguish the infundibular recess and mammillary body in 8 and could not any in 1.The process of ETV was smooth in 143 cases,difficult in 33 and could not be completed in 2.Conclusions There is a greater variation in the anatomic form of the third ventricle floor in patients with hydrocephalus.Some characteristics in the third ventricle floor such as heavy thickness,sinking and incline can increase the procedure difficulty of ETV.The contraindications of ETV are the condition under which the infundibular recess,mammillary body and translucent membrane can not be identified at all.