神经内镜造瘘术治疗颅内病变372例

Neuroendoscopic treatment for 372 cases of intracranial lesions

目的探讨神经内镜造瘘术在治疗颅内病变中的作用。方法回顾性分析广东省人民医院神经外科1998年5月至2010年5月使用神经内镜造瘘术治疗的颅内病变的临床资料。选取具有代表性手术方式的病例共372例，手术包括神经内镜下第三脑室底造瘘术198例、神经内镜下第三脑室底造瘘加病变活检或切除术69例、透明隔造瘘术55例、脑室囊肿造瘘术50例。总结并分析其手术适应证的把握及手术效果。结果成功行造瘘术369例，2例改行其他手术，活检术未成功1例。短期内症状缓解347例（93．3％），症状无缓解23例（6．2％），死亡2例（0．5％）。术后半年第三脑室底造瘘术手术无效22例（9．5％），透明隔囊肿造瘘术无效23例（69．7％），脑室内囊肿造瘘术无效12例（26．7％）。结论神经内镜下第三脑室底造瘘术对于梗阻性脑积水疗效显著，但对于儿童须严格把握手术适应证；神经内镜造瘘术对于透明隔囊肿整体有效率不高，需严格把握手术适应证。

Objective To explore the application of neuroendoseopic treatment for intracranial lesions. Methods The clinic data of 372 patients with intracranial lesions, who underwent neuroendoscopic treatment at our department from May 1998 to May 2010, were reviewed retrospectively. Representative endoscopic treatments included endoscopic third ventriculostomy （ETV） （ n = 198 ）, ETV ＆ endoscopic biopsy （ n = 69 ） , neuroendoscopic ostomy for septum pellucidum fenestration （ n = 55 ） （ for septum pellucidum cysts, n = 37） and endoscopic cystoventriculostomy for ventricular cysts （ n = 50）. Their surgical indications and clinical outcomes were summarized for analysis. Results ETV was performed successfully in 369 cases. Among them, 2 failed cases underwent other operations and endoscopic biopsy failed in 1 case. Within a short post-operative period, the symptoms were resolved in 347 cases （93.3%）, showed no improvement in 23 cases （6. 2% ） and 2 died （0. 5% ）. At Month 6 post-operation, a failure of ETV was detected in 22 cases （ 9. 5% ）, a failure of neuroendoscopic ostomy for septum pellucidum cysts in 23 （69. 7% ） and for ventricular cysts in 12 cases （26. 7% ）. Conclusion ETV is effective in the treatment of obstructive hydrocephlus, but its indication should be strictly controlled for children. Effective rate of neuroendoscopic treatment for intracranial septum pellucidum cysts remains unsatisfactory so that its operative indication should be strictly controlled.