ENDOSCOPIC TREATMENT OF LOCULATED HYDROCEPHALUS
ENDOSCOPIC TREATMENT OF LOCULATED HYDROCEPHALUS
复制标题
DOI：
10.3171/jns.1995.82.5.0780
复制
发表时间：
1995-05-01
影响因子：
4.1
通讯作者：
CRONE, KR
中科院分区：
文献类型：
--
作者：
LEWIS, AI;KEIPER, GL;CRONE, KR
局限性脑积水仍然是一个困难的神经外科问题，旨在通过脑室系统导航的内窥镜提供了一种新的治疗选择。作者回顾了1990年3月至1993年6月期间使用可操纵纤维内窥镜治疗34例局限性脑积水的经验，以评价内窥镜囊肿开窗术的疗效。治疗的目的是控制脑积水，简化原有的分流系统，并降低手术发病率。在8 - 45个月（平均26个月）的随访期内，内窥镜囊肿开窗术将分流系统翻修率从内窥镜检查前的每年3.04例降低至术后的每年0.25例。然而，8名患者（23.5%）需要14次重复手术来控制局限性脑积水。内窥镜检查后，多房性脑积水患者分流功能障碍的风险增加近5倍（相对风险4.85），囊肿复发的风险增加超过2倍（相对风险2.43）。同样，12例在内镜检查前分流的患者中有6例（50%）需要重复内镜检查（相对风险5.56）。虽然可能需要重复内镜手术来控制脑积水，但内镜囊肿开窗术避免了21例单灶性脑积水患者中7例（33%）的分流管放置。在作者的早期经验中遇到的一名患者需要开颅术以开窗治疗多发性脑室囊肿。内镜下并发症包括脑脊液漏1例，脑室炎1例。作者得出结论，内窥镜治疗腔隙性脑积水是一种安全、微创的技术，应考虑作为初始治疗选择。
Loculated hydrocephalus remains a difficult neurosurgical problem and endoscopes designed to navigate through the ventricular system provide a new option for treatment. The authors review their experience, during the period March 1990 to June 1993, using a steerable fiberscope in 34 cases of loculated hydrocephalus to evaluate the efficacy of endoscopic cyst fenestration. The goals of treatment were to control hydrocephalus, simplify preexisting shunt systems, and reduce operative morbidity. Endoscopic cyst fenestrations reduced the shunt revision rate from 3.04 per year prior to endoscopy to 0.25 per year after the procedure, during a follow-up period ranging from 8 to 45 months, mean 26 months. However, eight patients (23.5%) required 14 repeat operations to control loculated hydrocephalus. After endoscopy, patients with multiloculated hydrocephalus had a nearly fivefold increased risk (relative risk 4.85) for shunt malfunction and more than a twofold increased risk (relative risk 2.43) for cyst recurrence versus patients with uniloculated hydrocephalus. Similarly, six (50%) of 12 patients shunted prior to endoscopy required a repeat endoscopic procedure (relative risk 5.56). Although repeat endoscopic procedures may be required to control hydrocephalus, endoscopic cyst fenestration avoided placement of a shunt in seven (33%) of 21 patients with uniloculated hydrocephalus. One patient, encountered early in the authors' experience, required a craniotomy for fenestration of multiple ventricular cysts. Endoscopic complications included cerebrospinal fluid leakage in one case and ventriculitis in another. The authors conclude that endoscopic treatment of loculated hydrocephalus is a safe, minimally invasive technique that should be considered as the initial treatment option.