内镜第三脑室造瘘手术技术探讨

Study on operational technique for endoscopic third ventriculostomy (ETV)

目的探讨内镜第三脑室造瘘术(ETV)处理非交通性脑积水的手术技巧。方法回顾性分析58例非交通性脑积水病人接受的58次ETV手术及其近期随访的临床、影像资料。结果平均随访9.8个月。至复查时脑积水临床改善49例(84.5%),无变化7例(12.1%),恶化2例(3.4%)。51例获得影像学随访,41例(80.4%)脑积水改善,第三脑室缩小;15例(29.4%)脑积水无变化;2例(3.9%)脑积水加重,行脑室-腹腔分流手术。发生并发症8例(13.9%)8种14次,多为暂时性,2例(3.4%)为永久并发症,无手术死亡。结论ETV处理非交通性脑积水效果较好。为进一步减少并发症的发生,术者应熟悉脑室系统解剖,熟练内镜器械操作;正确选择头位、入颅点、内镜方向和造瘘口位置;务必探查脚间池,打开Liliequist膜;退镜后封闭皮质隧道;妥善止血,无菌操作。

s: Objective To probe into the techniques of endoscopic third ventriculostomy (ETV) for the treatment of non-communicating hydrocephalus. Methods Latest clinical follow-up results and imaging data of 58 ETVs in 58 patients with non-communicating hydrocephalus were evaluated retrospectively. Results Fifty-eight patients, 35 male, 23 female,were followed up for a mean of 9.8 months (ranged form 3 to 18 months). After ETVs, 49 patients (84.5%) exhibited distinct improvements, 7 patients (12.1%) displayed no change, and 2 patients (3.4%) demonstrated worsen, clinically; Fifty-one patients were followed up by CT or MRI scanning. Of 41 patients (80.4%), the hydrocephalus improved with narrowed third ventricles; of 15 patients (29.4%), the hydrocephalus showed no changes; of the last 2 patients (3.4%), the hydrocephalus aggravated and then the patients received V-P shunt. Complications occurred in 8 cases (13.9%) with 8 kinds and 14 times. Most of them were in a short term; there were no death correlated with ETVs, and only 2 cases (3.4%) presented permanent serious defects. Conclusion ETV for the treatment of non-communicating hydrocephalus was efficacious. To reduce the complication, knowing the anatomy of ventricles intimately and practiced neuroendoscopic manipulation are very important. The correct choice of head position,bar hole position,the endoscope direction and the position of fenestration of third ventricle floor are all important factors for the succeed ETV. The Liliequist membrane must be opened when it was found in interpeduncular cyst. The cortical tunnel defect must be sealed off after the endoscope pulled out. It is also important to emphasize hemostasis and aseptic manipulation during the operation.