Comparative Analysis of Cerebrospinal Fluid Dynamics in the Ventriculo-Cisternal Fluid Pathway and Shunt-independent Arrested Hydrocephalus after Neuroendoscopic Ventriculostomy

在内窥镜手术前后，用心门电影模式磁共振成像(MRI)描绘不同个体特殊病理生理的脑脊液(XSF)动力学特征。应用神经内窥镜手术治疗具有特殊病理生理特征的各种形式的脑积水，包括长期存在的成年显性脑积水(LOVA)、单侧单侧脑积水(IUH)、孤立性IV脑室(IFV)、不成比例大IV型脑室(DLFV)、孤立性菱形脑室(IRV)、孤立性四脑室肿大(IQV)、全脑前脑背囊(DS)和室前脑室(LV)。这些手术包括III脑室造口术、经吻合口和尾侧入路中脑导水管成形术、大脑膜孔/大脑孔成形术、隔膜造口术、IV脑室造口术、室间隔造口术、IV脑室造口术蛛网膜下腔开窗开窗术或…阻塞脑室的囊性肿瘤开窗术在不切除肿瘤和背囊脑室吻合术的情况下，脑室扩大的变化较为复杂，反映了脑实质顺应性和术后校正的脑脊液主干通路血流动力学的差异。有梗阻性脑积水和出血或感染病史的患者可能是ETV的良好候选者，其安全性和成功率与更一般患者系列的患者相当。同时遭受出血和感染的患者不适合接受ETV，除了少数病例和作为最后手段的治疗。在出血后接受分流术的患者中，ETV非常成功。对于有原发性导水管狭窄的患者，甚至在有出血或脑脊液感染病史的患者中，该手术也非常成功。结果发现，手术目的是通过打开脑室隔离，但并不总是通过与脑池的沟通，尤其是在婴儿中，可以达到创造停滞性脑积水状态的手术目的。这可能是由于婴儿蛛网膜下腔脑脊液动力学的不成熟所致。电影模式MRI是一种非常有用的评估脑脊液主要通路的脑脊液动力学的方法。较少

The characteristics of the cerebrospmal fluid (XSF) dynamics in the individual specific pathophysiologies were delineated by cardiac-gated cine-mode magnetic resonance imaging (MRI) before and after the endoscopic procedure. Neuroendoscopic surgery was used tp treat patients with various forms of hydrocephalus with specific pathophysiology, including long-standing overt ventriculomegaly in adulthood (LOVA), isolated unilateral hydrocephalus (IUH), isolated IV ventricle (IFV), disproportionately large IV ventricle (DLFV), isolated rhombencephahc ventricle (IRV) isolated quarto-ventriculomegaly (IQV), dorsal sac in holoprosencephaly (DS) and loculated ventricle (LV).These procedures included III ventnculostomy, aqueductal plasty by both rostral and caudal approaches, foraminal plasty in the foramen of Monro/foramen of Magendie, septostomy, IV ventnculostomy, fenestration of septation in the loculated ventricle fenestration of arachnoid cyst or cystic tumor obstructing a ventricle with or … More without tumor removal and dorsal sac ventnculostomy The postoperative changes of ventriculomegaly were complicated, reflecting the differences in the brain parenchymal compliance and postoperatively corrected CSF flow dynamijcs in the major CSF pathway. Patients with obstructive hydrocephalus and a history of either hemorrhage or infection may be good candidates for ETV with safety and success rates comparable with those in more general series of patients. Patients who have sustained both hemorrhage and infection are poor candidates for ETV, except m selected cases and as a treatment of last resort. In patients who have previously undergone shunt placement posthemorrhage, ETV is highly successful. It is also highly successful m patients with primary aqueductal stenosis even in those with a history of hemorrhage or CSF infection. It was found that the operative goal creating the state of arrested hydrocephalus, could be obtained by opening the ventricular isolation but not always by achieving communication with the cisterns especially in infants. This may be due to the immaturity of the subarachnoid CSF dynamics in the infants. Pre-and postoperative cine-mode MRI is a very useful ijiethod of estimating the CSF dynamics in the major CSF pathway. Less