神经内镜下三脑室底造瘘术治疗脑积水及并发症的防治

Complications of endoscopic third ventriculostomy for hydrocephalus

目的 探讨神经内镜下三脑室底造瘘术（ETV）治疗脑积水术后并发症的成因及防治.方法 自2008年9月至2013年9月河南省新乡市中心医院神经外科应用ETV治疗梗阻性脑积水15例,交通性脑积水5例,分析其常见并发症的防治.结果 20例均获得良好效果,其中16例症状体征消失,脑室恢复正常,间质水肿消失;4例症状和（或）体征好转,脑室缩小和（或）间质水肿好转.术后短期发热5例,切口愈合不良2例,头皮下积液2例,颅内感染1例.结论 严格把握ETV适应证,依据三脑室底部解剖特点,选择个体化造瘘方法;术后早期腰穿放液,可以明显减少手术并发症,提高手术质量.

Objective To explore the complications of endoscopic third ventriculostomy （ETV） for hydrocephalus and examine their preventions.Methods From September 2008 to September 2013,ETV was offered for obstructive hydrocephalus （n =15） and communicating hydrocephalus （n =5）.And the prevention and treatment of common complications were analyzed.Results All had achieved satisfactory outcomes.For 16 cases,their symptoms and signs disappeared,ventricle returned to normal and interstitial edema resolved;for another 4 cases,there were improvements of symptoms and （or） signs,ventricular shrinking and/or interstitial edema lessening.And the postoperative complications included fever （n =5）,poor healing of incision （n =2）,scalp hydrops （n =2） and intracranial infection （n =1）.Conclusion The indications of ETV should be selected strictly according to the specific anatomical characteristics of bottom of third ventricle.And individualized methods of stoma are necessary.And early postoperative lumbar puncture and drainage may obviously reduce complications and improve surgical outcomes.