Endoscopic third ventriculostomy for hydrocephalus
Endoscopic third ventriculostomy for hydrocephalus
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DOI：
10.1055/s-2008-1053384
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发表时间：
1999-09-01
影响因子：
--
通讯作者：
Mascari, C
中科院分区：
文献类型：
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作者：
Gangemi, M;Donati, P;Mascari, C
作者报告了125例在意大利三家神经外科中心接受内窥镜第三脑室造口术治疗梗阻性脑积水的患者。本组病例包括原发性输水管狭窄77例，外源性肿瘤压迫所致三室脑积水33例，四室脑积水15例。手术主要在全身麻醉下使用柔性内窥镜进行。术后MRI主要表现为第三脑室体积减小和开窗水平出现信号空洞。颅内高压、头围增大和Parinaud综合征的症状对内窥镜治疗反应更频繁。在该系列中，总体良好结果率（分流独立患者）为86.4%；原发性导水管狭窄（93.5%）和外部压迫引起的三室脑积水（84.8%）与较高的发生率相关！术后效果优于四室脑积水（53.3%）。由于该技术的侵入性非常低，术后死亡率低，术后并发症很少且通常是短暂的，作者建议当第三脑室足够大且脑脊液吸收没有改变时，扩大内镜下第三脑室造瘘术的适应症。
The authors report on 125 patients who underwent endoscopic third ventriculostomy for obstructive hydrocephalus in three Italian Neurosurgical Centers. The series includes 77 cases of primary aqueductal stenosis, 33 with triventricular hydrocephalus due to external tumor compression, and 15 with tetraventricular hydrocephalus. The operations were carried out mainly under general anesthesia, using a flexible endoscope. Decrease of size of the third ventricle and the presence of a signal void at the level of the fenestration are the main postoperative MRI findings. Signs of intracranial hypertension, increased head circumference and Parinaud syndrome respond more frequently to the endoscopic treatment. The overall rate of good results (shunt-independent patients) in this series is 86.4%; primary aqueductal stenosis (93.5%) and triventricular hydrocephalus due to external compression (84.8%) are associated to the higher rate! of good postoperative results than tetraventricular hydrocephalus (53.3%). Because of the very low invasivity of this technique, the absence of postoperative mortality and the scarce and usually transient postoperative complications, the authors advise to enlarge the indications for endoscopic third ventriculostomy to all patients with obstructive hydrocephalus when the third ventricle is large enough and there are no alterations of the CSF resorption.