第四脑室出口闭锁的神经内镜治疗

Endoscopic treatment for fourth ventricular outlet obstruction

目的探讨应用神经内镜治疗第四脑室出口闭锁（FVOO）的疗效。方法30例患者行第三脑室底造瘘术（ETV）。术中观察第三脑室底和基底池的情况。经扩张的导水管行第四脑室探查及出口膜性闭锁穿刺造瘘术。术后脑脊液电影成像（Cine-MR）检查评价导水管、第四脑室出口和第三脑室底造瘘口处的流量和流速变化。结果本组28例成功行ETV。6例经扩大的中脑导水管行第四脑室探查，其中2例行出口膜性闭锁穿刺造瘘术。随访时间0．5-4．0年。手术成功率是78．6％（22／28）。结论ETV是治疗第四脑室出口闭锁的有效方法。第四脑室出口膜性闭锁穿刺造瘘术的疗效尚需进一步观察。

Objective To explore the therapeutic efficacies of endoscope for fourth ventricular outlet obstruction（ FVO0 ）. Methods Endoscopic third ventriculostomy （ETV）was performed for 30 cases. The circumstances of third ventricular floor and basal cistern were observed and recorded intra- operatively. Meanwhile the fourth ventricular exploration and fistulation were performed across enlarged aqueduct. And the velocity and flow rate of aqueduct, fourth ventricular outlet and stoma were evaluated post- operatively with Cine-MR （magnetic resonance）. Results Standard ETV was performed successfully in 28 patients. Fourth ventricular exploration （ n = 6 ） and outlet membrane fistulation （ n = 2 ） were carried out. The mean follow-up period was 2. 3 years （range：0. 5 -4. 0）. The overall success rate was 78.6%. Conclusion ETV is a viable therapeutic option for FVO0 patients, The therapeutic effects of outlet membrane fistulation require further observations.