神经内镜下行三脑室底造瘘术治疗梗阻性脑积水的并发症分析和防治

目的:分析神经内镜下三脑室底造瘘术(ETV)的手术并发症原因,探讨其防治要点。方法:通过回顾性分析2004年9月至2006年2月应用ETV连续治疗梗阻性脑积水55例的手术并发症,对ETV的常见并发症的原因做了探讨。结果:54例患者ETV得以完成,术后50例患者恢复良好,脑积水症状明显减轻或消失。4例患者症状复发或加重,行脑室腹腔分流术。术后并发症包括硬膜下积液8例,发热15例,2例伴有脑膜刺激征为颅内感染,癫痫1例,硬膜外出血1例,头皮下积液8例。结论:熟悉三脑室底的解剖结构,选择合适的造瘘方法,并注意手术前后脑脊液动力学的变化,可以减少三脑室底造瘘治疗梗阻性脑积水的手术并发症。

Complication of endoscopic third ventriculostomy for obstructive hydrocephalus

Objective: To analyze the complication of endoscopic third ventriculostomy for obstructive hydrocephalus (ETV) and discuss its precaution.Methods: Through retrorespective anaylsis of the commplications of 55 consecutive cases (from December 2004 to February 2006), who were undergone endoscopic third ventriculostomy for obstructive hydrocephalus, and investigate the causes of common complications of endoscopic third ventriculostomy for obstructive hydrocephalus; Results: Fifty patients got well after operation, whose signs of hydrocephalus greatly relived or disappeared; signs recurred or deteriorated in four patients undergone ventriculoperitoneal shunt, postoperative complications including:8 cases suffered from subdural hygromas, 8 subscalp effusion, 15 fever, lepilepsy andlextradural hematoma.Conclusions: Being faliliar with the anatomy of the third ventricle, selecting proper mean to complete endoscopic third ventriculostomy,paying attention to the changes of pre and post operation in cerebral spinal fluid dynamics, may contribute to reduce the incidence of complications in endoscopic third ventriculostomy for obstructive hydrocephalus.