Fourth ventriculostomy: an alternative treatment for hydrocephalus due to atresia of the Magendie and Luschka foramina
Fourth ventriculostomy: an alternative treatment for hydrocephalus due to atresia of the Magendie and Luschka foramina
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DOI：
10.3171/2010.11.peds1080
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发表时间：
2011-02-01
影响因子：
1.9
通讯作者：
da Silva, Marcia Cristina
中科院分区：
文献类型：
--
作者：
Giannetti, Alexandre Varella;Malheiros, Jose Augusto;da Silva, Marcia Cristina
Magendie和Luschka孔闭锁是阻塞性脑积水的罕见原因。虽然这种情况已被经典的治疗脑脊液分流，最近的治疗还包括内镜下第三脑室造口术。在本研究中，作者介绍了一例脑积水患者，在CSF分流系统故障后使用了替代方法。一名年轻女性患者在出生后1年内放置了分流系统，直到8岁时情况良好。她因CSF分流故障的体征被急诊科收治5次。每次CT扫描都显示侧脑室和第三脑室轻微扩张，第四脑室大幅度增大。相比之下，当患者无症状时，在先前的成像研究中获得的心室较小。磁共振成像显示所有脑室都有轻微扩张，第四脑室明显增大。无导水管狭窄。第四脑室两侧侧隐窝明显增大提示有椎间孔闭锁的可能。门罗孔和第三脑室内的宽度不允许内窥镜通过。决定通过第四脑室内窥镜打开这些孔。全身麻醉诱导后，患者处于俯卧位，在左侧旁正中和枕下区域钻孔。将内窥镜引入小脑半球下方。然后，作者能够区分第四脑室底和其他解剖标志。通过侧隐窝的导航使他们能够看到关闭椎间孔的精细膜。这些膜用单极烧灼器作为钝性器械打开。然后用3 Fr Fogarty导管扩大开口。作者还打开了位于Magendie孔处的隆起薄膜。在术后期间，作者观察到患者的警觉状态明显改善，头痛消失，呕吐停止。此外，患者步态共济失调改善缓慢。术后6个月的MR成像显示第四脑室的大小明显减小。手术后36个月，患者仍然表现良好。内窥镜下第四脑室造口术，即打开第四脑室的3个孔，可能是这些结构先天性闭合的病例的替代治疗方法。(DOI：10.3171/2010.11.PEDS1080）
Atresia of the foramina of Magendie and Luschka is a rare cause of obstructive hydrocephalus. Although this condition has been classically treated by CSF shunting, recent treatments have also included endoscopic third ventriculostomy. In the present study, the authors present the case of a patient with hydrocephalus in whom an alternative method was used following a CSF shunt malfunction.A young female patient in whom a shunt was placed during the patient's 1st year of life was faring well until she was 8 years old. She was admitted to the emergency department 5 times with signs of CSF shunt malfunction. Each time, the CT scan showed a slight dilation of the lateral and third ventricles and a large increase in the size of the fourth ventricle. In comparison, ventricles were smaller in a previous imaging study obtained when the patient was asymptomatic. Magnetic resonance imaging showed the same slight dilation of all the ventricles and a significant increase in the fourth ventricle. There was no aqueductal stenosis. An important enlargement of both lateral recesses of the fourth ventricle suggested the possibility of an atresia of the foramina. The foramen of Monro and the width of the third ventricle would not allow the passage of an endoscope. The decision was made to open those foramina endoscopically through the fourth ventricle. After induction of general anesthesia, with the patient in the prone position, a bur hole was made in the left paramedian and suboccipital region. The endoscope was introduced underneath the cerebellar hemisphere. The authors were then able to distinguish the floor of the fourth ventricle and other anatomical landmarks. Navigation through the lateral recesses allowed them to see the fine membranes closing the foramina. These membranes were opened with a monopolar cautery as a blunt instrument. The orifice was then enlarged with a 3 Fr Fogarty catheter. The authors also opened a bulging thin membrane located at the foramen of Magendie. During the postoperative period, the authors observed a marked improvement in the state of the patient's alertness as well as a disappearance of her headaches and cessation of vomiting. In addition, the patient's gait ataxia improved slowly. Six-month postoperative MR imaging demonstrated an unequivocal reduction in the size of the fourth ventricle. The patient was still doing well 36 months after the surgery.Endoscopic fourth ventriculostomy, the opening of the 3 foramina of the fourth ventricle, may be an alternative treatment in cases in which these structures are congenitally closed. (DOI: 10.3171/2010.11.PEDS1080)