导水管梗阻所致巨大脑室脑积水的内镜治疗

目的 探讨导水管梗阻所致巨大脑室脑积水手术治疗的指征及并发症预防.方法 神经内镜下共治疗32例巨大脑室脑积水患者,其中25例行经额入路第三脑室底造瘘术,1例行经额小脑上池囊肿造瘘术,5例行枕下入路内镜下后颅窝囊肿切除、囊腔枕大池造瘘,1例行经枕下入路导水管成形术.结果 术后随访1-4年,32例具有行走不稳、尿失禁、智商下降、精神运动发育迟缓的患者中,26例症状明显改善,6例症状未继续进展.6例术前存在高颅压症状患者术后症状改善,除1例出现硬膜下积液外,无其他严重并发症发生.结论 巨大脑室脑积水并非内镜手术治疗禁忌,凡影像检查确定为导水管梗阻所致的巨大脑室脑积水,均应积极手术治疗,改进手术方法 可以避免严重并发症的发生.

Endoscopic treatment of ventriculomegaly hydrocephalus caused by primary or secondary aqueduct obstruction

Objective To explore the indications of surgical treatment of ventriculomegaly hydrocephalus caused by primary or secondary aqueduct obstruction and the prevention of complications. Method Endoscopic treatment of 32 cases of overt ventriculomegaly patients in total, 25 cases were subject to transfrontal -approach endoscopic third ventriculostomy, 1 case was subject to SCC cyst fistulation, 5 cases was subject to suboccipital - approach endoscopic skull cranial fossa cyst resection and cyst - cistema magnafistulation and 1 case was subject to suboccipital approach hydrocephalus plasty. Results After 1-4 years of follow - up, among 32 cases of patients of unstable walking, urinary incontinence, decreased intelligence quotient, psychomotor retardation, the symptoms of 26 cases were significantly improved and the symptoms of 6 cases of patients showed no continuous progression. The post - surgical symptoms of the six cases of patients with preoperative high intracranial pressure symptoms were improved. Conclusions The magnetic resonance imaging test shows the aqueduct stenosis or obstruction is a clear indication of patients of overt ventriculomegaly no matter whether there is clinical symptom of intracranial hypertension or not after surgical treatment As long as attentions are paid to the details during the operation process, the improvement of surgical techniques can avoid the occurrence of complications.