神经内镜下脑室内金属支架置入术治疗孤立颞角

Endoscopic intraventricular metal stent placement for treatment of entrapped temporal horn

目的探讨在神经导航及虚拟内窥镜的辅助下,采用内镜下颞角脑室造瘘+脑室内金属支架置入术治疗孤立颞角的效果。方法选取2011年1月-2016年12月解放军总医院神经外科13例非肿瘤占位引起的孤立颞角患者。将患者术前MRI数据(T1、T2、3D-SPACE等序列)导入3D Slicer软件中,三维重建患者的虚拟内窥镜,据此设计造瘘口并制订手术方案。在神经导航的辅助下,采用内镜直视下颞角脑室造瘘并释放金属支架。观察手术成功率、临床症状的改善,并定量计算颞角体积的变化。结果纳入患者男8例,女5例,年龄4～60岁,平均年龄36.4.±15.0岁。没有手术相关并发症发生,所有患者临床症状均较术前有所改善,未发现症状加重及出现新的神经系统症状。平均随访时间24.7±20.4(4～59)个月。术后4个月孤立颞角的体积(67.41±89.9) ml较术前(100.59±108.3) ml显著下降(P=0.006),平均体积变化率为35.50%±32.03%。其中1例体积虽无明显变化,但临床症状改善较明显;1例术后1个月时体积下降20.69%,但是术后4个月与术前比较,孤立颞角体积增加24.75%,患者没有出现头晕头痛等症状再次加重的情况,无肢体无力症状,仍正常上班,头颅MRI可见支架位置良好但支架内有脉络丛堵塞。结论在虚拟内窥镜及导航协助下,内镜下颞角脑室造瘘+金属支架置入术治疗孤立颞角,取得了较好的治疗效果。

Objective To report our experiences in treatment of entrapped temporal horn (ETH)by endoscopic temporal horn ventriculostomy and stent implantation with the aid of virtual endoscopy and neuro navigation.Methods Thirteen patients with ETH not caused by tumor who were treated by endoscopic temporal horn-ventriculostomy and metal stent implantation in Chinese PLA General Hospital from January 2009 to December 2016 were included in our study.The conception of virtual reality and 3D reconstruction software were applied to rebuild patients'ventricular system based on MRI data (included T1,T2 and 3D- SPACE images)before surgery.The virtual endoscopy and neuro navigation were used to optimize the plan.The endoscopic temporal horn ventriculostomy and metal stent implantation were performed.The operation successful rate and the improvements of clinical symptoms were observed,and the volumes of the cysts on MR images before surgery,and at 4 months after surgery were reconstructed by 3D Slicer and quantitatively calculated to compare the volumetric changes as well.Results There were 8 males and 5 females included in our study,with average age of (36.4.±15.0) years (range,4-60years).No procedure-related complication occurred,and all patients showed improvement of clinical symptoms without any stent-related technical complications. The mean follow-up time was (24.7±20.4) months (range,4-59 months).The volume of ETH decreased significantly at 4 months after surgery when compared with before surgery [(67.41±89.9)ml vs (100.59±108.3)ml,P=0.006],with an average decrease of (35.50±32.03)%.The volume of ETH in one patient remained unchanged but his symptoms relieved obviously.The volume of EHT decreased by 20.69% in one patient at 1month after surgery,whereas it increased by 24.75% at 4 months after surgery when compared with before surgery.The aggravation of headache or the weakness of limbs did not occurred.This patient was still at work, and his MRI scans showed correct placement of the metal stent,whereas it occluded by the choroid plexus.Conclusion With the aid of virtual endoscopy and neuro navigation,endoscopic temporal horn ventriculostomy and metal stent implantation shows efficacy in treatment of ETH.