神经内镜第三脑室底造瘘术在后颅窝肿瘤梗阻性脑积水中的应用价值

Clinical experience of endoscopic third ventriculostomy in treatment of posterior cranial fossa tumor complicated with obstructive hydrocephalus

目的探讨神经内镜下第三脑室底造瘘术(ETV)在后颅窝肿瘤梗阻性脑积水和同期行后颅窝肿瘤显微切除术中的临床应用价值。方法回顾性分析重庆大学附属肿瘤医院神经肿瘤科2015年7月—2018年12月,应用ETV治疗53例后颅窝肿瘤并梗阻性脑积水并同期行肿瘤切除术患者的临床资料。分析患者的疗效及预后。结果本组患者术后6 h内复查头部CT,均无脑室内积血、积气。术后出现短暂性发热患者5例;无出现继发性出血、手术死亡及严重后遗症的患者。术后随访患者6~31个月,其中有效患者50例(94.3%);无效患者3例,后行腰大池引流1周,最终行脑室-腹腔分流。结论后颅窝肿瘤并梗阻性脑积水患者行开颅显微手术前,行脑室外引流及分流是传统的处理方式,但也是并发症较多的治疗方法;同期ETV对于此类梗阻性脑积水的治疗符合生理机制,并发症少,疗效更好,值得在临床推广应用。

Objective To investigate the clinical effects of endoscopic third ventriculostomy(ETV)in treatment of posterior cranial fossa tumor complicated with obstructive hydrocephalus in one-stage resection.Methods The clinical data of 53 patients of posterior cranial fossa tumor with obstructive hydrocephalus underwent surgical tumor removal between July 2015 and December 2018 were analyzed retrospectively.Results Of 53 patients,no intraventricular hematoma and intracranial pneumatosis were found through CT scan within 6 hours after operation.Fever occurred in 5 cases.No secondary bleeding,surgical death and severe sequelae occurred.Among 53 patients,the improvement rate of clinical symptoms was 94.3%(50/53)in symptomatic patients after operation.The follow up period ranged from 6 to 31 months.Three patients with obstructive hydrocephalus was failed to endergo ETV and lumbar cistern drainage for one week,but satisfying postoperative results were obtained in ventriculoperitoneal shunt later.Conclusions In patients with posterior fossa tumor complicated with obstructive hydrocephalus,external ventricular drainage and shunt before craniotomy are more traditional methods,but it is also recognized as a treatment with higher complications.ETV can produce good results through simple surgical procedures for treatment of hydrocephalus in posterior fossa tumors with less trauma and complications.