Surgical Indication for Neuroendoscopic Ventriculostomy and Local Fine ICP Dynamics/CSF Flow Dynamics

尽管神经内窥镜手术，特别是治疗非交通性脑积水已得到广泛应用，但明确的适应证及术前术后疗效评价仍是脑积水研究的未来课题。神经内窥镜手术用于治疗具有特定病理生理的各种形式脑积水患者，包括成人长期公开性脑室肿大（LOVA）、孤立性单侧脑积水（IUH）、孤立性第四脑室（11W）、不成比例大第四脑室（DLFV）、孤立性斜脑室（IRV）、孤立性四脑室肿大（IQV）、无前脑畸形（DS）背囊和室位化（LV）。脑脊液（CSF）在个体特定病理生理学中的动态特征通过心门控电影模式磁共振成像（MM）在内窥镜手术前后描述。脑室肿大的术后改变更为复杂，反映了脑实质顺应性和术后纠正的脑脊液主要通路中脑脊液血流动力学的差异。LCP动态，通常在继发性脑积水的相对急性或亚急性期，脑实质顺应性保存良好。分流术中少量的脑脊液引流可使高振幅的压力波正常化（HCA iii期）。相比之下，在相对较低的ICP水平阶段可能需要低压或极低压系统。失去顺应性，通常脉冲压力范围小，基线压力相对较低。（晚期HCA ii期和晚期HCA iv期）。在这些阶段，分流系统应该消除轻度异常高的压力波，甚至在正常但相对较高的ICP水平内。本项目1996-1998年取得的成果包括：1)首次试验并确立了“实验动物神经内窥镜”概念；2)分析了局部精细颅内压动力学/脑脊液血流动力学；3)提出了成人脑积水的LOVA、True NPH、脑积水性痴呆（HD）等脑积水新概念；4)建立了脑室造口术的神经内窥镜手术技术和指征。少

Although the neuroendoscopic surgery, especially for treatment of non communicating hydrocephalus, has been widely applied, the definitive indication for and preoperative evaluation for postoperative efficacy remain the future subjects in hydrocephalus research. Neuroendoscopic surgery was used to treat patients with various forms of hydrocephalus with specific pathophysiology, including long-standing overt ventriculomegaly in adult (LOVA), isolated unilateral hydrocephalus (IUH), isolated fourth ventricle (11W), disproportionately large fourth ventricle (DLFV), isolated rhombencephalic ventricle (IRV), isolated quarto-ventriculomegaly (IQV), dorsal sac in holoprosencephaly (DS), and loculated ventricle (LV). The characteristics of the cerebrospinal fluid (CSF) dynamics in the individual specific pathophysiologies were delineated by cardiac-gated cine-mode magnetic resonance imaging (MM) before and after the endoscopic procedure. The postoperative changes of ventriculomegaly were compl … More icated, reflecting the difference in the brain parenchymal compliance and postoperatively corrected CSF flow dynamics in the major CSF pathway. LCP dynamics, usually in a relatively acute or subacute period in secondary hydrocephalus, the brain parenchymal compliance is well preserved. Small amount of CSF withdrawal by the shunt may normalize the high amplitude of pressure waves (HCA Stage-III). In contrast, a low- or extremely-low-pressure system may be necessary in the stage of relatively low ICP level. The compliance is lost and usually pulse pressure is small in range, with relatively low baseline pressure. (late HCA Stage-Ill and HCA Stage-IV). In these stages, a shunt system should delete the pressure waves ranging in a mildly abnormally high or even within a normal but relatively high ICP level.The results obtained from this project in 1996-1998 included1) The first trial and established concept of "Experimental Animal Neuroendoscopy", 2) Analyses of the local fine ICP dynamics/CSF flow dynamics, 3) Proposal of new concepts of hydrocphalus, i.e., LOVA, True NPH, hydrocephalic dementia (HD) in adult hydrocephalus, and 4) Established neuroendoscopic surgical technique and indication for ventriculostomy. Less