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

虽然神经内镜手术，尤其是非交通性脑积水的治疗已得到广泛应用，但其确切的适应证和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学的各种形式的脑积水患者，包括成人长期显性脑室扩大（LOVA），孤立性单侧脑积水（IUH），孤立性第四脑室（11 W），不成比例大的第四脑室（DLFV），孤立性菱形脑室（IRV），孤立性第四脑室扩大（IQV），无前脑畸形背侧囊（DS），和房室腔（LV）。在内窥镜手术前后，通过心脏门控电影模式磁共振成像（MM）描绘了个体特定病理生理学的脑脊液（CSF）动力学特征。脑室扩大术后改变复杂， ...更多信息 这反映了脑实质顺应性和主要CSF通路中术后校正的CSF流动动力学的差异。LCP动力学，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。分流管抽取少量CSF可使压力波的高振幅正常化（HCA III期）。相反，在ICP水平相对较低的阶段，可能需要低压或极低压系统。顺应性丧失，通常脉压范围较小，基线压力相对较低。(late HCA第III阶段和HCA第IV阶段）。1996-1998年本项目取得的成果包括：1）首次试验并确立了“实验动物神经内镜”的概念; 2）局部精细颅内压动态/脑脊液流动动力学分析; 3）提出了新的脑积水概念;也就是说，LOVA、True NPH、成人脑积水中的脑积水性痴呆（HD）; 4）已确立的神经内镜手术技术和脑室造口术适应症。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