Endoscopic third ventriculostomy.
Endoscopic third ventriculostomy.
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内窥镜第三脑室造口术。
DOI：
10.1097/00006123-199001000-00012
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发表时间：
1990
期刊：
影响因子：
4.8
通讯作者：
M. Brydon
中科院分区：
文献类型：
--
作者：
Robert Jones;W. Stening;M. Brydon
脑积水的长期颅外分流术具有许多与分流故障和感染相关的缺点。在某些情况下，结果非常令人失望。我们通过使用颅内脑脊液改道术（即第三脑室造口术）成功治疗了 5 名获得性导水管狭窄患者，没有出现明显的发病率。由丹迪首先倡导的脑室造口术基本上被忽视，取而代之的是颅外手术。然而，随着手术技术的改进，脑室造口术现在被认为是某些病例的可行替代方案。在另外 19 名患者中，我们随后扩大了患者选择范围，将患有 Arnold-Chiari 畸形、先天性非交通性脑积水和肿瘤的患者纳入其中。这些儿童中三分之二没有进行分流，除了一名儿童术后出现偏瘫外，没有出现明显的发病情况。尽管晚发组的效果最好，但即使是早发的非交通性脑积水也已得到成功治疗。即使在第三脑室造口术失败并随后需要脑室腹腔分流术的患者中，我们预计他们对分流术的依赖性仍然较低，因为他们的脑积水现在正在连通，而脑积水往往不会出现如此迅速的发作或颅内压升高。
Long-term extracranial shunting for hydrocephalus has numerous drawbacks related to shunt malfunction and infection. In some cases outcome has been very disappointing. We successfully managed 5 patients with acquired aqueductal stenoses with no significant morbidity by the use of an intracranial cerebrospinal fluid diversion, namely a third ventriculostomy. First advocated by Dandy, ventriculostomy was largely passed over in favor of extracranial procedures. With improved surgical techniques, however, ventriculostomy is now considered to be a viable alternative in selected cases. In a further 19 patients, we subsequently broadened our patient selection to include those with Arnold-Chiari malformations, congenital noncommunicating hydrocephalus, and tumors. Two thirds of these children remain without shunts and apart from 1 child developing hemiplegia postoperatively, there has been no significant morbidity. Although the best results have been seen in the late onset groups, even early onset, noncommunicating hydrocephalus has been successfully managed. Even in patients in whom third ventriculostomy has failed and who have subsequently required ventriculoperitoneal shunts, we anticipate that they will remain less dependent on shunts because their hydrocephalus is now communicating, which tends not to have such a rapid onset or extreme levels of raised intracranial pressure.